儿童肺炎链球菌脑膜炎的临床特点分析

Clinical characteristics of streptococcus pneumococcal meningitis in children

目的探讨儿童肺炎链球菌(SP)脑膜炎的临床特点及SP菌株的耐药性。方法选取2013年3月-2018年10月于河南省某医院住院诊治的SP脑膜炎患儿16例作为研究对象,收集研究对象的临床资料,对其临床特点及SP菌株的耐药性进行分析。结果研究对象年龄≤1岁7例,年龄>1岁9例;病程为(4.24±4.76)d。研究对象均有高热(T>38.5℃),8例出现全身性抽搐,10例有昏迷及嗜睡等严重意识障碍。13例研究对象白细胞计数明显异常,9例脑脊液压力>200mm H2O(1mm H2O=9.806Pa),10例脑钠肽(BNP)水平>1000 pg/mL,13例合并低钠血症,10例合并低钙血症。后遗症情况:脑积水合并硬膜下积液4例,癫痫3例,肢体活动障碍3例,昏迷2例。预后情况:11例治愈出院,3例死亡,2例自动出院治疗。预后不良的研究对象出现白细胞异常、低钙血症、低钠血症、高BNP水平及高脑脊液蛋白水平的人数比例明显高于预后较好的研究对象。对分离出的SP菌株进行耐药性分析,发现SP对克林霉素、红霉素、四环素、复方磺胺的耐药率均高于80.00%,而SP对美罗培南、头孢吡肟、奎奴普丁/达福普丁耐药率较低(均为6.25%),未发现万古霉素、替利霉素、利奈唑胺、左旋氧氟沙星耐药菌株。结论SP脑膜炎患儿病情危重,后遗症发生率高,实验室检查结果异常程度对预后判断有一定意义。此外,SP对儿科临床常用抗菌药物耐药严重,需谨慎应用。

Objective To investigate the clinical features of streptococcus pneumococcal(SP)meningitis in children and the resistance of SP strains.Methods A total of 16 children with SP meningitis who were hospitalized in a hospital in Henan province from March 2013 to October 2018 were enrolled.The clinical data of the subjects were collected,and their clinical characteristics and drug resistance of SP strains were analyzed.Results There were seven subjects≤1 year old and nine subjects>1 year old;the course of disease was(4.24±4.76)d.All subjects had high fever(T>38.5℃),eight subjects developed systemic convulsions,and 10 had severe disturbances such as coma and lethargy.13 subjects had abnormal leukocyte counts,9 had cerebrospinal fluid pressure(CFP)>200 mm H2O(1mm H2O=9.806Pa),10 had brain natriuretic peptide(BNP)>1000 pg/mL,13 had hyponatremia,and 10 had hypocalcemia.The sequelae:four cases of hydrocephalus combined with subdural effusion,three cases of epilepsy,three cases of physical activity disorder and two cases of coma.Prognosis:11 subjects were cured and discharged,three subjects died,and two were discharged automatically.The proportion of subjects with poor prognosis who had abnormal leukocyte counts,hypocalcemia,hyponatremia,high BNP levels,and high CFP levels was significantly higher than those with better prognosis.The drug resistance analysis of the isolated SP strains showed that the resistance rates of SP to clindamycin,erythromycin,tetracycline and compound sulfonamide were all higher than 80.00%,while those of SP to meropenem,cefepime,quinupristin/dalfopristin were low(all at 6.25%),and vancomycin-,tellthromycin-,linezolid-,and levofloxacin-resistant strains were not found.Conclusion Children with SP meningitis are critically ill and have a high incidence of sequelae.The abnormal degree of laboratory findings has a certain significance for prognosis.Besides,SP is highly resistant to commonly used antibiotics in pediatric clinics,so they should be applied with caution.