地塞米松辅助抗感染治疗对小儿难治性化脓性脑膜炎的疗效分析

Effect of adjuvant therapy with dexamethasone on treatment of children with refractory purulent meningitis

目的分析小儿难治性化脓性脑膜炎(PM)的病原菌、耐药性特点及地塞米松辅助治疗效果。方法以2012年6月-2017年6月收治的210例难治性PM患儿为研究对象,均行病原菌培养及耐药性分析,将210例患儿均分为两组,对照组给予抗感染(抗菌药物)治疗,观察组在对照组基础上加用地塞米松辅助治疗,比较两组临床疗效。结果共检出病原菌210株,其中革兰阳性菌163株,占77.62%,以表皮葡萄球菌54株及肺炎链球菌43株为主,革兰阴性菌47株以肺炎克雷伯菌21株为主;革兰阳性菌中表皮葡萄球菌、肺炎链球菌、溶血性葡萄球菌对左氧氟沙星的耐药率均为100.00%;革兰阴性菌中肺炎克雷伯菌对庆大霉素耐药率为100.00%;观察组治疗总有效率为91.43%高于对照组的80.95%(χ2=4.841,P=0.028);观察组治疗前后血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)差值均大于对照组(t=8.457、4.763、8.019,P<0.001);两组患儿药物不良反应发生率比较差异无统计学意义。结论小儿难治性PM常见病原菌包括表皮葡萄球菌、肺炎链球菌等,对左氧氟沙星耐药率较高,加用地塞米松辅助治疗能明显提高疗效,抑制炎症反应。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from children with refractory purulent meningitis（PM）and observe the effect of adjuvant therapy with dexamethasone.METHODS A total of 210 children with refractory PM who were treated in the hospital from Jun 2012 to Jun 2017 were recruited as the study objects,the distribution and drug resistance of pathogens were observed,the enrolled children were divided into two groups,the control group was given anti-infection therapy（antibiotics）,the observation group was given adjuvant therapy with dexamethasone on basis of the treatment of the control group.The clinical curative effect was compared between the two groups.RESULTS Totally 210 strains of pathogens were isolated,163（77.62%）of which were gram-positive bacteria,47 were gram-negative bacteria;Staphylococcus epidermidis（54 strains）and Streptococcus pneumoniae（43 strains）were the predominant species of the gram-positive bacteria;Klebsiella pneumoniae（21 strains）was dominant among the gram-negative bacteria.The drug resistance rates of S.epidermidis,S.pneumoniae and Staphylococcus haemolyticus to levofloxacin were 100.00%.Among the gram-negative bacteria,the drug resistance rate of the K.pneumoniae to gentamicin was 100.00%.The total effective rate of treatment of the observation group was 91.43%,higher than 80.95% of the control group（χ2=4.841,P=0.028）.The difference values of serum C-reactive protein,tumor necrosis factor-α（TNF-α）and procalcitonin（PCT）before and after the treatment were greater in the observation group than in the control group（t=8.457,4.763,8.019,P〈0.001）.There was no significant difference in the incidence of drug-induced adverse reactions between the two groups of children.CONCLUSION The S.epidermidis and S.pneumoniae are the most common species of pathogens isolated from the children with refractory PM and are highly resistant to levofloxacin,the adjuvant therapy with dexamethasone may remarkably raise the curative effect and inhibit the inflammatory reactions.