深圳市婴儿B族链球菌脑膜炎临床特点分析

Clinical Features of Infants with Group B Streptococcus Meningitis in Shenzhen

目的:分析婴儿B族链球菌(GBS)脑膜炎的临床特点、药敏试验、抗生素治疗及预后。方法:回顾性分析2010年12月至2016年1月深圳市儿童医院收治的24例GBS脑膜炎患儿资料。结果:男17例,女7例,早发感染2例(8.3%),晚发感染22例(91.7%)。急性期血白细胞升高13例(54.2%),C反应蛋白升高17例(70.8%),降钙素原升高14例(87.5%,14/16)。B族链球菌对红霉素、克林霉素、四环素耐药率为41.7%、66.7%及95.8%,对青霉素、万古霉素、利奈唑胺100%敏感。抗生素治疗:美罗培南17例(70.8%),头孢菌素类或青霉素类抗生素7例(29.2%),联合使用利奈唑胺13例(54.2%),联合使用万古霉素5例(20.8%)。24例好转,5例发生并发症。结论:GBS菌株对青霉素、万古霉素、利奈唑胺敏感性高,对红霉素、克林霉素、四环素耐药率高。抗生素药敏结果与临床疗效不相符,预后欠佳。

Objective： To summarize the clinical features, drug sensitive test, antibiotic therapy and outcomes in the infants with group B Streptococcus （GBS） meningitis. Methods： The data of 24 children with group B Streptococcus meningitis who were hospitalized from December 2010 to January 2016 in Shenzhen Children＇ s Hospital were reviewed. Results： Twenty four children （ 17 boys, 7 girls） were diagnosed with GBS meningitis. Two cases （8.3%） were early-onset infection, and 22 cases （91.7%） were late-onset infection. In the acute phase, thirteen cases （54. 2% ） of white blood cell （WBC） , 17 cases （70.8%） of C-reactive protein and 14 cases （87.5%） of procalcitonin were elevated. The resistance rates to erythromycin, clindamycin, tetracycline were 41.7% , 66. 7%, 95, 8% whilst all of them were susceptible to penicillin, vancomycin and linezolide. Seventeen （70. 8% ） children used meropenem, 7 cases （29. 2% ） used penicillins or cephalosporins, there were 13 cases （54. 2% ） conbined with linezolid and 5 cases （20. 8% ） with vancomycin. Twenty- four cases were improved, and 5 cases were occurred complication. Conclusion： All of GBS are susceptible to penicillin, vancomycin and linezolide, the resistance rates are high to erythromycin, elindamycin and tetracycline. Antibiotic resistance and clinical efficacy is not consistent. The outcomes of GBS meningitis children are not good.