0~3月龄婴儿化脓性脑膜炎脑脊液病原菌分布及耐药性分析

Distribution and drug resistance analysis of cerebrospinal fluid pathogens in infants with purulent meningitis aged 0-3 months

目的了解0~3月龄婴儿化脓性脑膜炎病原菌的分布及耐药情况,以指导临床合理用药。方法选择2015-01-01—2019-12-31在郑州大学附属儿童医院新生儿诊疗中心住院的0~3月龄婴儿的5310份脑脊液标本为研究对象,对脑脊液培养阳性的化脓性脑膜炎婴儿病原菌分布及耐药情况进行分析。结果5310份CSF标本共检出细菌175株,其中革兰阳性(G+)菌的构成比为68%,革兰阴性(G-)菌的构成比为32%。早期新生儿、晚期新生儿及29 d^3月龄小婴儿3个年龄组CSF培养检出G+菌、G-菌构成比差异无统计学意义(P>0.05)。CSF培养检出率排名前7位的病原菌依次为大肠埃希菌、表皮葡萄球菌、屎肠球菌、溶血葡萄球菌、人葡萄球菌、肺炎克雷伯菌、B群无乳链球菌。CSF培养病原菌中耐药菌株较多,耐药率为44%。构成比位居前5位的多重耐药菌依次为耐甲氧西林凝固酶阴性葡萄球菌(32.5%)、产超广谱-内酰胺酶菌株(22.1%)、耐甲氧西林表皮葡萄球菌(19.5%)、碳青霉烯类耐药肠杆菌(14.3%)、氨基糖苷类高水平耐药菌株(7.8%)。CSF培养病原菌中G-菌的耐药率(58.9%)高于G+菌的耐药率(37%),差异有统计学意义(P<0.05)。结论我院0~3月龄化脓性脑膜炎患儿CSF培养病原菌以G+菌为主,对抗菌药物耐药率较高。临床医师应根据菌株特点和药物敏感性试验结果,合理选用抗菌药物。

Objective To understand the distribution and drug resistance of pathogenic bacteria in 0-3 months old infants with purulent meningitis,so as to guide the rational use of drugs.Methods A total of 5310 cerebrospinal fluid samples were selected as the study objects,which from infants aged 0 to 3 months who were admitted to the Center for Neonatal Diagnosis and Treatment of Children's Hospital Affiliated to Zhengzhou University from January 1,2015 to December 31,2019.The distribution and drug resistance of pathogenic bacteria in cerebrospinal fluid(CSF)culture were analyzed.Results A total of 5310 CSF specimens were found to be 175 strains of pathogenic bacteria,among which the composition ratio of gram-positive(G+)bacteria was 68%,that of gram-negative(G-)bacteria was 32%.There was no significant difference in the composition ratio of G+bacteria and G-bacteria detected in CSF culture in the early neonatal group,the late neonatal group and the 29d-3-month young infants(P>0.05).The top 7 pathogenic bacteria detected in CSF culture were escherichia coli,staphylococcus epidermidis,enterococcus faecalis,staphylococcus hemolyticus,staphylococcus humanis,klebsiella pneumoniae,and streptococcus amurensis.The drug resistance rate of CSF culture pathogens was high,and that of multi-drug resistant organismswas 44%.The top five MDRO were methicillin-resistant coagulase negative staphylococci(MRCNS)(32.5%),extended-spectrumβ-lactamase(ESBLs)(22.1%),methicillin-resistant staphylococcus epidermidis(MRSE)(19.5%),carbapenem-resistant Enterobacteriaceae(CRE)(14.3%)and high-level aminoglycoside resistant(HLAR)(7.8%).All the 6 HLAR strains were enterococcus faecalis.The drug resistance rate(58.9%)of G-bacteria in CSF culture was higher than that of G+bacteria(37%),and the difference was statistically significant(P<0.05).Conclusion In our hospital,G+bacteria were the main pathogens in CSF culture of patients aged 0-3 months,with a high resistance rate to antimicrobial drugs.Clinicians should choose the antimicrobial drugs reasonably according to the characteristics of the strain and the results of drug sensitivity test.