0~3岁儿童细菌性脑膜炎临床及病原学分析

Clinical and etiological analysis of bacterial meningitis in children aged 0~3 years

目的探讨新生儿和婴幼儿细菌性脑膜炎临床特征及脑脊液病原学差异,为本地区儿童细菌性脑膜炎早期诊疗提供依据。方法回顾性分析0~3岁细菌性脑膜炎患儿临床表现、脑脊液病原菌分布及耐药性。结果婴幼儿组较新生儿组更易出现呕吐和颈抵抗。主要病原菌为凝固酶阴性葡萄球菌(CoNS)、肺炎链球菌和大肠埃希菌,以革兰阳性菌为主,占76.67%(69/90)。肺炎链球菌多见于婴幼儿组,在新生儿组中未见,而CoNS多见于新生儿组。主要病原菌对青霉素类耐药率高,有些甚至高达100%。婴幼儿组肺炎链球菌和大肠埃希菌对头孢菌素类耐药率亦较高,但大肠埃希菌对阿米卡星、哌拉西林/他唑巴坦和碳青酶烯类敏感率100%;肺炎链球菌和CoNS对利奈唑胺和万古霉素耐药率为0,但对大环内酯类耐药率高达80%以上。结论新生儿组和婴幼儿组细菌性脑膜炎患儿临床表现和病原菌构成比存在差异,耐药性未见差异,但抗菌药物耐药率普遍增高,临床上应根据患者年龄,结合临床表现和病原菌结果,合理选用抗菌药物。

Objective To investigate differences in the clinical characteristics of bacterial meningitis and its cerebrospinal etiology between newborns and infants,so as to provide evidence for early diagnosis and treatment of bacterial meningitis in children of this area.Methods This study retrospectively analyzed the clinical manifestations,distribution of the cerebrospinal pathogens and their drug resistance in 0~3 years old children with bacterial meningitis.Results The infant group was more prone to vomiting and neck resistance than the newborn group.The main pathogens were coagulase negative staphylococcus(CoNS),Streptococcus pneumoniae and Escherichia coli,with gram-positive bacteria as the dominant,accounting for 76.67%(69/90).Streptococcus pneumoniae was more common in the infant group,but not in the newborn group.CoNS was more common in the newborn group.The resistance rates of the main pathogens to penicillin were high,and some were even as high as 100%.The resistance rates of streptococcus pneumoniae and Escherichia coli to cephalosporins were also higher in the infant group,but the sensitivity rates of Escherichia coli to amikacin,piperacillin/tazobactam and carbapenem were all 100%.The drug resistance rates of Streptococcus pneumoniae and CoNS to linezolid and vancomycin were 0,but their resistance rates to macrolides were more than 80%.Conclusion There are differences in clinical manifestations and pathogen composition between the newborn group and the infant group,and no differences in drug resistance.But the antimicrobial resistance rates are generally increased.Clinically,antibiotics should be selected rationally according to patients’age,clinical manifestations and pathogenic bacteria results.