儿童脑脊液培养阳性43例临床分析

Clinical analysis of 43 cases of positive culture of cerebrospinal fluid in children

目的 了解脑脊液培养在儿童细菌性脑膜炎（bacterial meningitis,BM）中的诊治价值.方法 对我院2008年1月至2012年12月脑脊液培养阳性患儿的临床特点、病原菌种类及实验室检查、治疗经过以及疾病转归进行分析.结果 脑脊液培养阳性病例共43例,13例被确诊为BM.分离出最多的病原菌是凝固酶阴性葡萄球菌（51.2％,22/43）,其中伴有脑脊液常规、生化检查结果异常者仅1例,所有血培养均为阴性,未更换为药敏试验提示的敏感抗生素治疗,患儿均治愈.分离出无乳链球菌4株、肺炎链球菌2株及革兰阴性杆菌4株,所有病例均有脑脊液常规异常,大多数伴有脑脊液生化异常及血培养阳性.结论 脑脊液中分离出的凝固酶阴性葡萄球菌多为污染菌.无乳链球菌、肺炎链球菌及革兰阴性杆菌的检出对BM诊断意义大.BM的诊断一定要结合脑脊液培养、常规、生化及血培养等结果及临床表现综合分析,可避免不必要地使用抗菌药物.

Objective To evaluate the significance of cerebrospinal fluid（CSF） culture in diagnosis and treatment of childhood bacterial meningitis（BM）.Methods Clinical data were collected and the etiology,laboratory results,treatment and disease prognosis were analyzed in children with positive CSF culture during Jan 2011 to Dec 2012 in our hospital.Results A total of 43 organisms were detected from CSF,13 cases of which were clearly diagnosed as BM.The coagulase negative staphylococcus was isolated most frequently （51.2%,22/43）,meanwhile,CSF routine examination and biochemical test were abnormal in only 1 case.All results of blood cultures were negative.All cases were cured without changing antibiotics according to the drug sensitive test.Four strains of Streptococcus agalactiae,2 strains of Streptococcus pneumohiae and 4 strains of gram-negative bacilli were separated.Routine examinations of all CSF were abnormal in most cases,the CSF biochemical tests were abnormal and blood cultures were positive.Conclusion Coagulase negative staphylococcus separated in most CSF is contaminated bacteria.Streptococcus agalactiae,Streptococcus pneumoniae and gram-negative bacilli separated in CSF have important diagnostic value in BM.Diagnosis of BM should be combined with CSF culture,routine examination,biochemical test,blood culture results and clinical manifestations,then we can avoid unnecessary usage of antibiotics.