新生儿大肠杆菌化脓性脑膜炎临床特点及大肠杆菌菌株的分子分型研究  

The clinical features and molecular typing of Escherichia coli in neonatal purulent meningitis

作　　者：丁翊君[1] 张金晶[1] 王亚娟[1] 姚开虎[1] 高薇[1] 吴丹[1] 

机构地区：[1]首都医科大学附属北京儿童医院新生儿科,100045

出　　处：《北京医学》2016年第8期774-777,共4页Beijing Medical Journal

基　　金：北京市自然科学基金青年基金项目(7154196)

摘　　要：目的探讨新生儿大肠杆菌化脓性脑膜炎的临床特点、诊治及分子分型特征。方法收集我院2009年10月至2015年4月新生儿科收治的临床诊断为化脓性脑膜炎且脑脊液培养为大肠杆菌的新生儿,记录患儿围生期情况、临床表现、实验室检查、治疗经过及预后等,并对大肠杆菌菌株进行超广谱β-内酰胺酶(ESBL)检测及多位点序列(MLST)分型。结果共收治15例大肠杆菌化脓性脑膜炎患儿,男6例,女9例;生后发病≤7 d 2例,>7 d 13例。14例患儿有发热,9例有嗜睡、拒乳,4例有抽搐,2例有哭闹烦躁,1例予经鼻持续气道正压通气(NCPAP)呼吸支持。实验室检查:WBC升高(>15×109/L)7例,WBC降低2例(<5×109/L),CRP升高(>8 mg/L)13例。15例脑脊液白细胞均明显升高(>500×106/L),均以多核为主;12例糖降低(<2.2 mmol/L);14例蛋白升高(>1 500 mg/L)。ESBL检测结果:ES-BL阳性6例(40%)。MLST分型结果:ST 95 3例(20%),ST 1193 3例(20%),ST 62 3例(20%),ST 4456 2例(13.3%),ST 4702 1例(6.7%),ST 4381 1例(6.7%),ST 131 1例(6.7%),新型1例(6.7%)。10例应用美罗培南治疗,3例应用头孢曲松+青霉素,2例放弃治疗。2例患儿合并有硬膜下积液及脑室管膜炎。1例合并硬膜下积液。11例患儿治愈出院,2例好转出院,2例放弃治疗后死亡。结论新生儿大肠杆菌化脓性脑膜炎以晚期新生儿多见,病情凶险,美罗培南治疗效果较好,对于治疗迁延的患儿,应注意特殊基因型的大肠杆菌感染。Objective To study the clinical characteristics, diagnosis, therapy and molecular characteristics of neo- natal purulent meningitis caused by Escherichia coli（E, coli）. Methods Fifteen cases ofE. coli meningitis admitted into the neonatal department of the Hospital from October 2009 to April 2015 were retrospectively analyzed. The perinatal peri- od situation, clinical manifestations, laboratory examinations, treatment and prognosis, etc., and E. coli strains ESBL and MLST were tested. Results A total of 15 cases of E. coli purulent meningitis were treated, among them 6 cases were male, 9 cases were female; 2 cases had symptoms~〈7 days, 13 cases of them 〉 7 days. For clinical manifestations： 14 cases of children had fever, 9 cases had drowsiness and refusing to take milk, 4 cases with convulsions, 2 cases with crying. 1 case used NCPAP breathing support. For laboratory examinations, 7 cases had elevated white blood cell （〉 15 × 10^9/L）, 6 cases of them had normal WBC count, 2 cases had reduced WBC count（ 〈 5 × 10^9/L）, 13 cases of them had elevated CRP level（ 〉 8 mg/L）. White blood cells in the CSF of 15 cases were significantly higher （ 〉 500× 10^6/L）, CSF sugar were reduced （ 〈 2.2 mmol//L） in 12 cases, and the protein level of CSF was elevated （ 〉 1 500 mg/L ） in 14 cases. ESBL test results showed that 6 cases （40%） were positive. MLST classification results revealed that ST 95 subtype in 3 cases （20%）, ST 1193 in 3 cases （20%）, ST 62 in 3 cases （20%）, ST 4456 in 2 cases （13.3%）, ST 4702 in 1 case （6.7%）, ST 4381 in 1 case （6.7%）, ST 131 in 1 case （6.7%）, new type in 1 case （6.7%）. Antibiotics treatment included meropenem（10 cases） and penicillin＋ceftriaxone（3 cases）. Eleven cases were cured, 2 cases improved, 2 cases died after giving up treatment. Conclusion Neonatal E. coli meningitis is a serious clinical condition with high mortality. Meropenem has good efficacy. When the clinical situation is refractory, attent

关 键 词：大肠杆菌 化脓性脑膜炎 婴儿 新生儿 

分 类 号：R722.1[医药卫生—儿科]