细菌性脑膜炎病原菌分布及抗生素应用与耐药的关系

Distribution of Neonatal Bacterial Meningitis Pathogens and Antimicrobial Resistance

目的了解细菌性脑膜炎病原菌的分布特点以及抗生素应用与耐药性的关系,为临床合理选用抗生素治疗提供依据。方法对某医院新生儿科2000年1月-2005年12月临床诊断为细菌性脑膜炎患儿的脑脊液进行普通培养和高渗培养,用法国生物梅里埃系统鉴定细菌,以K-B法进行药敏分析。结果有156份脑脊液培养出了病原菌,主要为表皮葡萄球菌、大肠埃希菌、溶血葡萄球菌。早期新生儿组革兰阴性杆菌检出率比晚期新生儿组高,晚期新生儿组革兰阳性球菌检出率比早期新生儿组高。革兰阴性杆菌对亚胺培南、头孢曲松、头孢哌酮等较敏感,革兰阳性球菌对头孢噻肟、头孢哌酮、头孢曲松等较敏感;使用过抗生素患儿检出产耐药酶菌的比率明显高于未使用过抗生素患儿(χ2=7.68,P<0.05),尤其使用过第三代头孢菌素的患儿检出产耐药酶菌的比率显著高于后者(χ2=10.04,P<0.005)。结论新生儿细菌性脑膜炎病原菌以革兰阳性球菌为主,其分布与新生儿肺炎病原菌有相关性。合理应用抗生素尤其第三代头孢菌素,减少耐药菌株的产生。

Objective To investigate the pathogen distribution in bacterial meningitis and the relationship between the use of antibiotics and drug resistance; and to provide a basis for reasonable use of antibiotics. Methods The cerebrospinal fluid of newborns who were diagnosed with bacterial meningitis was carried on hypertonic training and general training from January, 2000 to December, 2005. The French Biomerieux Identification System was used to identify bacteria and the susceptibility to antimicrobial was analyzed by Kirby- Bauer method. Results There were 156 specimens of cerebrospinal fluid in which pathogens had been found during this five - year period. The leading pathogens were S. epidermidis, E. coil and S. hemolytic. The newborns had higher Gram- negative bacilli infection and the late neonate group had higher Gram - positive cocci infection. The Gram - negative bacilli was more sensitive to antimicrobial drugs such as imipenem, ceftriaxone, cefoperazone and so on. The Gram- positive cocci were more sensitive to antibiotics such as cefotaxime, cefoperazone, ceftriaxone, etc. Increased percentages of antimicrobial resistance strains were observed among those newborns who had received antimicrobial drugs （X^2 = 7.68, P〈0.05）. In particular, the use of third-generation cephalosporins- resistant bacteria had significantly higher output ratio （X^2 = 10.04, P〈0. 005）. Conclusion The main pathogen of neonate bacterial meningitis is Gram- positive coccus, whose distribution is correlated with neonatal pneumonia pathogens. Rational use of antibiotics, especially rational use of the third- generation cephalosporins, can reduce the resistant strains.