儿童化脓性脑膜炎的病原菌分布及其耐药情况分析

Pathogenic Bacteria Distribution and Drug Resistance of Children with Purulent Meningitis

目的分析儿童化脓性脑膜炎(PM)的病原菌分布及其耐药情况。方法选择东莞市厚街医院2010年12月—2014年12月收治的PM患儿64例,对患儿的血液与脑脊液实施病原菌培养,分析病原菌分布情况,并统计病原菌对常用抗菌药物的耐药情况。结果本组共培养出细菌56株,其中革兰阳性球菌34株(占60.7%)、革兰阴性杆菌22株(占39.3%)。革兰阳性球菌中表皮葡萄球菌19株(占55.9%),肺炎链球菌3株(占8.8%),溶血葡萄球菌2株(占5.9%),金黄色葡萄球菌2株(占5.9%),其他葡萄球菌8株(占23.5%);革兰阴性杆菌中大肠埃希杆菌13株(占59.1%),肺炎克雷伯杆菌4株(占18.2%),不动杆菌1株(占4.5%),阴沟肠杆菌1株(占4.5%),产气肠杆菌1株(占4.5%),其他2株(占9.1%)。革兰阳性球菌对头孢唑林、头孢曲松、万古霉素、克林霉素、庆大霉素、亚胺培南及丁胺卡那霉素的耐药率较低,均≤50.0%;革兰阴性杆菌对头孢曲松和亚胺培南的耐药率较低,均<10.0%。结论儿童PM的病原菌主要为革兰阳性球菌,主要革兰阳性球菌为表皮葡萄球菌,主要革兰阴性杆菌为大肠埃希杆菌和肺炎克雷伯杆菌,临床应根据患儿病原菌耐药情况合理使用抗菌药物。

Objective To analyze the pathogenic bacteria distribution and drug resistance of children with purulent meningitis. Methods A total of 64 children with purulent meningitis were selected in Houjie Hospital of Dongguan from December 2010 to December 2014, and their blood and cerebrospinal fluid were collected and cultivated to analyze the pathogenic bacteria distribution and drug resistance to common antibiotics. Results A total of 56 strains of pathogenic bacteria were cultivate out, including 34 strains of Gram - positive coccus （ accounting for 60. 7% ） , 22 strains of Gram - negative bacilli （accounting for 39. 3% ）. Of the 34 strains of Gram - positive coccus, 19 strains were Staphylococcus epidermidis （accounting for 55.9% ）, 3 strains were Streptococcus pneumoniae （ accounting for 8.8% ）, 2 strains were Staphylococcus haemolyticus （accounting for 5.9% ） , 2 strains were Staphylococcus aureus （ accounting for 5.9% ） , 8 strains were other Staphylococcus （accounting for 23.5% ）. Of the 22 strains of Gram - negative bacilli, 13 strains were Escherichia coli（ accounting for 59. 1% ） , 4 strains were Klebsiella pneumoniae （accounting for 18.2% ） , 1 strain was Acinetobacter （accounting for 4. 5% ） , 1 strain was Enterobacter cloacae （accounting for 4. 5% ） , 2 strains were other bacilli （accounting for 9. 1% ）. Drug sensitive test results showed that, the drug resistant rate to cefazolin, ceftriaxone, vancomyein, clindamycin, gentamicin, imipenem and amikacin of Gram - positive coccus were all equal or less than 50. 0% ; the drug resistant rate to ceftriaxone and imipenem of Gram- negative bacilli were both less than 10.0%. Conclusion Gram -positive coccus is the major pathogenic bacteria of children with purulent meningitis, mainly is Staphylococcus epidermidis; of Gram - negative bacilli, Escherichia coli and Klebsiella pneumonia are common; clinicians should reasonably use antibiotics according to the drug resistance of pathogenic bacteria.