2016—2023年宝鸡市儿童细菌性脑膜炎病原分布及耐药分析

Bacterial spectrum distribution and antimicrobial resistance profile of bacterial meningitis among children in Baoji city from 2016 to 2023

目的分析宝鸡市儿童细菌性脑膜炎的主要致病菌分布和耐药情况。方法基于急性脑膜炎脑炎症候群监测项目,对2016年1月—2023年12月宝鸡市妇幼保健院报告的774例细菌性脑膜炎病例,采集脑脊液标本,开展细菌培养和抗菌药物敏感试验。结果共分离到阳性菌株105株,检出率为13.57%(105/774),其中革兰阳性菌占80.00%(84/105),以表皮葡萄球菌、人葡萄球菌和肺炎链球菌为主;革兰阴性菌占20.00%(21/105),以大肠埃希菌为主。全年每个月份均有病原菌检出,3月份和9月份(占26.67%,28/105)为两个高峰,年龄最小的为出生后20 min,最大的9岁;不同年龄组病原菌检出率差异有统计学意义(χ^(2)=35.91,P<0.05),其中幼儿组检出率低于婴儿组、学龄前期和学龄期组(χ^(2)值分别为15.01、7.09、10.08,P值均<0.05),幼儿组与新生儿组比较,差异无统计学意义(χ^(2)=1.60,P>0.05)。新生儿组病原菌占44.76%(47/105),以大肠埃希菌、表皮葡萄球菌为主;婴儿组占26.67%(28/105),以肺炎链球菌为主;幼儿组占3.81%(4/105),以表皮葡萄球菌为主;学龄前期组占11.43%(12/105),以表皮葡萄球菌为主;学龄期组占13.33%(14/105),以肺炎链球菌为主。主要病原菌药物敏感试验结果显示表皮葡萄球菌对氨苄西林/舒巴坦、克林霉素、左氧氟沙星的耐药率分别为47.06%(8/17)、41.18%(7/17)和23.53%(4/17),对万古霉素和利奈唑胺完全敏感;肺炎链球菌对红霉素和克林霉素的耐药率均为100.00%(13/13),对青霉素耐药率为69.23%(9/13),对万古霉素和利奈唑胺完全敏感;大肠埃希菌对氨苄西林、左氧氟沙星、头孢曲松、头孢噻肟的耐药率分别为66.67%(8/12)、41.67%(5/12)、33.33(4/12)%和41.67%(5/12),对氨苄西林/舒巴坦、头孢哌酮/舒巴坦、阿米卡星和美罗培南敏感;无乳链球菌对青霉素、利奈唑胺和万古霉素敏感,对红霉素、克林霉素、氨苄西林和左氧氟沙星存在耐药。结论表皮葡萄球菌、肺炎链球菌和大肠埃希菌是引起本地区儿童细菌性脑膜炎最常见的病原菌,不同年龄组细菌分布不同,临床可根据本地病原菌分布特点和药敏试验结果尽早对细菌脑膜炎病例进行诊治。

ObjectiveTo analyze the bacteria spectrum and antimicrobial resistance profile of bacterial meningitis among children in Baoji.MethodsBased on the acute meningeal and encephalitis syndrome surveillance project,cerebrospinal fluid samples were collected from 774 cases of bacterial meningitis in Baoji Municipal Maternal and Health Hospital from January 2016 to December 2023.Bacterial culture and drug sensitivity test were carried out.ResultsA total of 105 positive strains were isolated with the detection rate of 13.57%(105/774).Among them,gram-positive strains accounted for 80.00%(84/105),mainly including Staphylococcus epidermidis,Staphylococcus hominis,and Streptococcus pneumoniae.Gram-negative bacteria accounted for 20.00%(21/105),and the predominant strain was Escherichia coli.Pathogenic bacteria were detected in every month of the year,with two peaks in March and September(26.67%,28/105).The youngest was infected 20 min after birth,and the oldest was nine years old.There were statistical differences in the detection rates among different age groups(χ^(2)=35.91,P<0.05).The positive rate in the toddler group was lower than that in the infant group,the pre-school age group and the school age group,respectively(χ^(2)=15.01,7.09,and 10.08;all P<0.05).There was no statistical difference between the toddler group and the neonate group(χ^(2)=1.60,P>0.05).The strains detected in the neonate group accounted for 44.76%(47/105),mainly including Escherichia coli and Staphylococcus epidermidis;the strains in the infant group accounted for 26.67%(28/105),mainly including Streptococcus pneumoniae;the strains in the toddler group accounted for 3.81%(4/105),mainly including Staphylococcus epidermidis;the strains in the pre-school age accounted for 11.43%(12/105),mainly including Staphylococcus epidermidis;the strains in the school age group accounted for 13.33%(14/105),mainly including Streptococcus pneumoniae.The results of drug sensitivity test showed that the resistance rates of Staphylococcus epidermidis to ampicillin/sulbactam,clindamycin,and levofloxacin were 47.06%(8/17),41.18%(7/17),and 23.53%(4/17),respectively.Staphylococcus epidermidis strains were sensitive to vancomycin and linezolid.All of the Streptococcus pneumoniae strains were resistant to erythromycin and clindamycin,but sensitive to vancomycin and linezolid.The resistance rate of Streptococcus pneumoniae to penicillin was 69.23%(9/13).The resistance rates of Escherichia coli to ampicillin,levofloxacin,ceftriaxone,and cefotaxime were 66.67%(8/12),41.67%(5/12),33.33%(4/12),and 41.67%(5/12),respectively,but they were sensitive to ampicillin/sulbactam,cefoperazone/sulbactam,amikacin,and meropenem.Streptococcus agalactis strains were sensitive to penicillin,linezolid,and vancomycin,but resistant to erythromycin,clindamycin,ampicillin,and levofloxacin.ConclusionsThe main pathogens causing bacterial meningitis in Baoji city are Staphylococcus epidermidis,Streptococcus pneumoniae,and Escherichia coli.The distribution of bacteria is varied in different age groups.The diagnosis and treatment of bacterial meningitis should be made based on the bacterial spectrum characteristics and the results of antimicrobial resistance profile.