儿童细菌性脑膜炎致病菌分布和耐药性及临床特点10年变迁  

Ten-year changes in pathogen, antimicrobial susceptibility and clinical feature of children with bacterial meningitis

作　　者：李鸿[1] 张玉琴[1] 张金婷[1] 朱近[1] 刘晓军[1] 王怀礼[1] 叶露梅[1] 

机构地区：[1]天津市儿童医院内科,300074

出　　处：《中华儿科杂志》2009年第4期272-275,共4页Chinese Journal of Pediatrics

摘　　要：目的分析比较儿童细菌性脑膜炎（BM）近10年间在病原菌分布、耐药情况及其临床特点的变化，为临床诊治提供指导。方法回顾分析10年中我院126例14岁以下BM患儿的临床资料，并将1998年1月至2002年12月的64例设为1组，2003年1月至2007年12月的62例设为2组，比较两组临床特点、病原菌分布及其耐药情况的变迁。结果2组最常见的致病菌为凝固酶阴性葡萄球菌（17／62，27．4％）和大肠埃希菌（9／62，14．5％），而在1组二者所占比例分别为12／64（18．8％）和5／64（7．8％）。耐苯唑西林的凝固酶阴性葡萄球菌2组13／19（68．4％）高于1组2／12（16．7％）（P〈0．05）。126例中出现抽搐42例，2组11／62（17．7％）低于1组31／64（48．4％，P〈0．01）；意识障碍16例，2组4／62（6．4％）低于1组12／64（18．8％）（P〈0．05）；出现并发症37例，2组13／62（21．0％）低于1组24／64（37．5％）（P〈0．05）；遗留神经系统后遗症34例，2组11／62（17．7％）低于1组23／64（35．9％）（P〈0．05）；但更改经验治疗2组21例（21／62，33．9％）高于1组7例（7／64，10．9％）（P〈0．01）。结论（1）儿童BM病原菌凝固酶阴性葡萄球菌、大肠埃希菌等条件致病菌构成增加。（2）病原菌耐药菌株明显增多，给临床治疗带来困难，应及时调整治疗方案。（3）儿童BM临床重症表现减少，出现并发症、后遗症的比率降低，但治疗不顺利情况增多。Objective Despite progress in antibiotic therapy and intensive care, childhood bacterial meningitis （BM） remains a devastating disease. We conducted this study to investigate the changes in clinical characteristics, the etiologic agents and antimicrobial susceptibility of BM during the past 10 years in children under 14 years of age. Methods These 126 patients were divided into two groups according to their date of admission. Group 1 included 64 patients admitted from January 1998 to December 2002, and group 2 included 62 cases admitted from January 2003 to December 2007. All pediatric medical charts of them were reviewed. Results The predominant isolated bacteria from CSF were coagulase-negative staphylococcus（ 17/62,27.4% ） and Escherichia coli （9/62, 14. 5% ） in group 2. The resistance rate of staphylococcus against oxacillin（MRS） was 68.4% （13/19） in group 2, significantly higher than that of group 1 （ 16. 7% , 2/12）. Among 126 cases, 42 had seizure attack and 16 had consciousness disturbance,the proportions of them in group 2 （ 11/62, 17.7% ; 4/62, 6. 4% ） were lower than those in group 1 （31/64, 48.4%; 12/64, 18. 8%, P 〈 0.05）. Cases in group 2 survived with complications [ 13/62 （21.0%） ] and sequelae [ 11/62 （ 17.7% ） ] were lower than those in group 1 （24/64, 37. 5%, 23/64, 35. 9% ,P 〈0. 05） ,but the rate of empirical therapy modification in group 2（21/62, 33.9% ） was higher than that in group 1 （7/64, 10. 9% , P 〈 0. 01 ）. Conclusion The predominant bacteria in children with BM are staphylococcus and Escherichia coli in recent years. The antibiotic resistance rate of bacteria has been higher year after year. The clinical patterns of pediatric BM have changed with a decrease in clinically serious eases, complications and sequelae, but an increase in modification of empirical therapy.

关 键 词：儿童 脑膜炎 细菌性 抗药性 细菌 

分 类 号：R686[医药卫生—骨科学]