新生儿化脓性脑膜炎脑脊液病原菌分布和耐药性分析

Pathogens and drug resistance analysis of cerebrospinal fluid in neonatal purulent meningitis

目的探讨新生儿化脓性脑膜炎脑脊液病原菌分布、抗生素敏感和耐药情况,为临床诊治提供实验室依据。方法对临床诊断的28例化脓性脑膜炎患儿脑脊液细菌培养和耐药性以及敏感性进行分析。结果 28例化脓性脑膜炎患儿脑脊液病原菌分布:单菌株27例,双菌株1例。其中革兰阴性菌20株(68.96%),革兰阳性菌8株(27.59%),白色念珠菌1株(3.45%)。革兰阴性菌对氨苄西林、复方新诺明、哌拉西林的耐药率达80.00%以上,对头孢唑林、四环素、头孢噻肟的耐药率在60.0%以上。共检出产超广谱β-内酰胺酶菌8株,未检出对美罗培南耐药的革兰阴性菌。革兰阳性菌大部分对氨苄西林、复方新诺明、头孢西丁、红霉素耐药,未检出对万古霉素耐药的革兰阳性菌。结论新生儿化脓性脑膜炎脑脊液病原菌以革兰阴性菌为主,对多种抗生素耐药。

Objective To investigate the bacteria distribution of neonatal purulent meningitis,antibiotic sensitivity and resistance,and provide laboratory evidence for clinical diagnosis and treatment.Methods Twenty-eight cases diagnosed purulent meningitis were recruited into this study.The bacterial culture,drug resistance and sensitivity of cerebrospinal fluid from the patients were analyzed.Results The pathogen distribution in the cerebrospinal fluid of 28 cases with neonatal purulent meningitis：27 cases with cultured single strain,just 1 case with two strains.In this findings,there were 20 gram-negative bacteria strains（68.96%）,8 grampositive bacteria strains（27.59%）,1 Candida albicans strain（3.45%）.The drug resistant rate of gram-negative bacteria to ampicillin,cotrimoxazole,piperacillin was more than 80.00%;on the other hand,it was up to 60.00%to cefazolin,tetracycline,cefotaxime.Eight strains of extended spectrum beta lactamase bacteria were tested in this study.Gram-negative bacteria resistant to meropenem and amikacin were not detected.Most gram-positive bacteria showed drug resistance to ampicillin,cotrimoxazole,erythromycin,cefoxitin.There was none detected in gram-positive bacteria resistant to vancomycin.Conclusion Gram-negative bacteria was the major pathogens in neonatal purulent meningitis,and tHcy were resistant to multiple antibiotics.