新生儿B族链球菌脑膜炎的临床特征和血清分型

Clinical analysis and serotypes distribution of neonatal purulent meningitis caused by group B streptococcus

目的探讨新生儿B族链球菌(GBS)脑膜炎的临床特点、药敏情况和血清分型,为新生儿GBS脑膜炎的防治和抗生素合理应用提供理论依据。方法收集2013年6月至2016年6月期间就诊于广州市妇女儿童医疗中心<90 d新生儿GBS脑膜炎病例。使用Vitek 2 Compact全自动细菌鉴定及药敏分析系统对GBS分离株进行鉴定和抗生素最小抑菌浓度(MIC)测定;乳胶凝集试验进行GBS荚膜多糖血清学分型。结果确诊新生儿GBS脑膜炎46例,早发型15例,晚发型31例。78.3%的GBS脑膜炎患儿存在不同程度的并发症,50%的早发型和44.8%的晚发型GBS脑膜炎存活患儿存在不同程度的神经系统后遗症。46例新生儿脑膜炎GBS分离株共检出4种血清型,最常见是血清Ⅲ型(73.9%),其次是Ⅰb(19.6%)、Ⅴ(4.3%)和Ⅰa型(2.2%)。46株GBS分离株药物敏感试验结果示:GBS对青霉素类、头孢菌素类、利奈唑胺和万古霉素100%敏感。结论广东地区新生儿GBS脑膜炎的主要流行型是高致病血清型-Ⅲ型。因此需要加强GBS侵袭性感染的流行病学监控及有效的预防措施的实施。

Objective To investigate the clinical characteristics, antibiotic susceptibilities and serotypes of Group B Streptococcus （GBS） isolated from neonatal meningitis to provide references for the prevention and treatment of neonatal GBS meningitis. Methods From June 2013 to June 2016, we surveyed the GBS strains isolated from purulent meningitis of 〈 90 days infants from Guangzhon Women and Children＇s Medical Center. The GBS isolates were identified and the minimum inhibitory concentration of the antibiotics was determined by Vitek 2 Compact automatic bacterial identification system. GBS serotyping was performed using Strep-B-Latex rapid latex agglutination test kit. Results A total of 46 cases of neonatal GBS meningitis, 15 cases of early-onset infection and 31 cases of late-onset infection were diagnosed. 78.3% of GBS meningitis with varying degrees of complications. Among 41 survivors with 3 - 24 months follow-up, 50% of the early-onset and 44.8% of the late-onset GBS meningitis with varying degrees of neurological sequelae. Four capsular types were identified among the 46 isolates, serotype-Ⅲ was the most prevalent （73.9%）, followed by Ⅰb （19.6%）, Ⅴ （4.3%） and Ⅰa （2.2%）. All the isolates were susceptible to penicillins, cephalosporins, linezolid and vancomycin. Conclusion The highly pathogenic serotype-Ⅲ was the predominant serotype among neonatal GBS meningitis in Guangzhou, Therefore, it is necessary to strengthen the epidemiological surveillance of GBS invasive infection and the effective implementation of preventive measures.