新生儿、儿童细菌性脑膜炎病原菌分布及耐药分析

Distribution and drug resistance analysis of pathogenic bacteria in neonatal/child bacterial meningitis

目的分析细菌性脑膜炎患儿的病原菌分布及其主要病原菌的耐药特点,为临床诊断与治疗用药提供帮助。方法回顾性分析广东省妇幼保健院2011年1月至2018年12月收治的脑脊液培养阳性并检出明确单一菌株的病例。根据时间段分为早年组(2011—2014年)和晚年组(2015—2018年),根据年龄分为新生儿组(0~28d)、婴儿组(28d^1岁)、儿童组(>1岁);分析各组病原菌分布及药敏结果。结果 共检出病原菌59株,患儿年龄从2d到14岁(年龄中位数为3个月),主要病菌为无乳链球菌19例(32.22%)、大肠埃希菌18例(30.51%)、肺炎链球菌16例(27.12%)。新生儿组无乳链球菌比例高于婴儿组及儿童组,差异有统计学意义(P<0.05)。儿童组肺炎链球菌比例高于新生儿及婴儿组,差异有统计学意义(P<0.05)。早年组无乳链球菌比例高于近年组,差异有统计学意义(P<0.05)。无乳链球菌对四环素及克林霉素耐药率高,对青霉素、头孢类、万古霉素敏感;大肠埃希菌ESBLS阳性率22.22%(4/18),对氨苄西林、阿莫西林耐药率较高;肺炎链球菌普遍耐药。结论 无乳链球菌为本地区细菌性脑膜炎的主要病原菌并且多发于新生儿,近年有下降趋势,儿童多见肺炎链球菌感染。近年来大肠埃希菌感染有上升趋势,肺炎链球菌感染率保持较高水平。肺炎链球菌耐药率较严峻,无乳链球菌和大肠埃希菌药敏未见明显异常,治疗儿童细菌性脑膜炎应及时经验用药,并进行细菌培养及药敏试验,根据药敏结果及时调整抗生素的选择。

Objective To analyze the distribution and the drug resistance characteristics of the main pathogens in children with bacterial meningitis (BM), and to provide assistance for the clinical diagnosis and treatment. Methods The cases positive in CSF culture and detected with clear single strains from January, 2011 to December, 2018 in Guangdong Maternal and Child Health Hospital were retrospectively analyzed. According to the onset time, the BM children were divided into an early group (2011-2014) and a late group (2015-2018). According to their age, the BM children were divided into a neonate group (0-28 days), an infant group (28 d-1 year), and a child group (≥1 year). The distribution of pathogens and drug susceptibility results of each group were analyzed. Results A total of 59 strains were detected. They were 2 days to 14 years old (median age 3 months). The main pathogens were Streptococcus agalactiae (19 strains), Escherichia coli(18 strains), and Streptococcus pneumoniae(16 strains). The proportion of Streptococcus agalactiae was higher in the neonatal group than in the infant group and the child group (P < 0.05). The proportion of Streptococcus pneumoniae was higher in the child group than in the neonatal group and the infant group (P < 0.05). The proportion of Streptococcus agalactiae was higher in the early group than in the late group (P < 0.05). The resistance rates of Streptococcus agalactiae to tetracycline and clindamycin were high;the positive rate of E. coli ESBLs was 22.22%(4/18), and the resistance rates to ampicillin and amoxicillin were higher;Streptococcus pneumoniae was generally resistant to commonly used antibiotics. Conclusion Streptococcus agalactiae is the main pathogen of bacterial meningitis in this area and occurs mostly in newborns. In recent years, there has been a downward trend, and children are more likely to have S. pneumoniae infection. In recent years, Escherichia coli infection has an upward trend, and the infection rate of Streptococcus pneumoniae remains high. The drug resistance rate of Streptococcus pneumoniae is severe, and there is no obvious abnormality in the drug sensitivities of Streptococcus agalactiae and Escherichia coli. In the treatment of bacterial meningitis in children, the drug should be used in time, and bacterial culture and drug sensitivity test should be carried out to adjust the choice of antibiotics.