儿童化脓性脑膜炎164例病原菌及耐药性分析

The Etiology and Antibiotic Resistance Patterns of Childhood Purulent Meningitis: A Report of 164 Cases

目的:分析江西省儿童医院儿童化脓性脑膜炎病原学特点,以供临床合理用药和治疗经验参考。方法:收集2009年1月至2011年7月江西省儿童医院收治的164例儿童化脓性脑膜炎(来自江西省四大地区)的血及脑脊液培养结果,分析其病原菌及耐药情况。结果:共有41例检出病原菌,脑脊液培养阳性菌主要是肺炎链球菌、表皮葡萄球菌、肺炎克雷伯菌、溶血性葡萄球菌;血培养阳性菌主要是肺炎链球菌、表皮葡萄球菌、肺炎克雷伯菌、大肠埃希菌。不同性别、季节、地区的病原菌分布差异无统计学意义(P>0.05);不同年龄段的病原菌分布差异有统计学意义(P<0.05),其中0～28 d组主要是表皮葡萄球菌、肺炎克雷伯菌、肠球菌,>28 d～1岁组主要是表皮葡萄球菌、金黄色葡萄球菌,>1岁～5岁组主要是肺炎链球菌和表皮葡萄球菌,>5岁～14岁组主要是肺炎链球菌和溶血性葡萄球菌。革兰阳性球菌多为耐甲氧西林菌株,普遍对万古霉素和利福平敏感;革兰阴性杆菌则普遍对亚胺培南和第三代头孢菌素敏感。结论:江西省儿童医院儿童化脓性脑膜炎病原菌主要为肺炎链球菌、表皮葡萄球菌和肺炎克雷伯菌等,其分布具有年龄差异性,临床经验用药时应根据其分布特点及耐药性情况合理选择抗生素。

Objective： To provide a theoretical basis for clinical empiric and rational medication according to the etiology of childhood purulent meningitis in Jiangxi province.Methods： Results of blood and cerebrospinal fluid culture of one hundred and sixty four children with purulent meningitis in Jiangxi Children＇ s Hospital from January 2009 to July 2011 were enrolled,and the pathogens and antibiotic resistance were analyzed.Results： Forty one cases were culture-positive（25.0%）.The positive bacteria isolated from cerebrospinal fluid samples were Streptococcus pneumonia,Staphylococcus epidermidis,Klebsiella pneumonia,and hemolytic staphylococci.The positive bacteria isolated from blood samples were mainly Streptococcus pneumonia,Staphylococcus epidermidis,Klebsiella pneumonia,and Escherichia coli.There were no significant differences of pathogens between the genders and among seasons and geography（P0.05）,while there was a significant difference between different age groups.The main pathogens were Staphylococcus epidermidis,Klebsiella pneumonia,and Enterococcus in the 0~28 days group;Staphylococcus epidermidis and Staphylococcus aureus in the 28 days^1 year group;Staphylococcus epidermidis and Streptococcus pneumonia in the 1 year^5 years group;Streptococcus pneumonia and hemolytic Staphylococcus aureus in the 5 years^14 years group.The gram-positive pathogens of childhood purulent meningitis in Jiangxi Province were generally sensitive to vancomycin and rifampin,while the Gram-negative ones were sensitive to imipenem and third-generation cephalosporins.The Staphylococcus aureus,Staphylococcus epidermidis and hemolytic staphylococci which were resistant to methicillin were significantly increased.Conclusions： The main pathogens of childhood purulent meningitis in Jiangxi Province were Streptococcus pneumonia,Staphylococcus epidermidis and Klebsiella pneumonia.We should choose antibiotics according to pathogen distribution of different age and drug sensitivity test results in the clinical practice.