细菌性脑膜炎患儿的病原菌分布特征及耐药性分析  

Distribution and Drug Resistance of Pathogenic Bacteria in Children with Bacterial Meningitis

作　　者：杨欢[1] 邵丽佳[2] 李佳慧[1] 周铁丽[1] 

机构地区：[1]温州医科大学附属第一医院医学检验中心,浙江温州325000 [2]金华中心医院检验科

出　　处：《解放军预防医学杂志》2017年第6期655-657,共3页Journal of Preventive Medicine of Chinese People's Liberation Army

基　　金：浙江省自然科学基金资助项目(No.LY14H190005);国家自然科学基金资助项目(No.81171614)

摘　　要：目的探讨60例细菌性脑膜炎(BM)患儿的病原菌分布特征及耐药情况。方法选取2006年5月-2015年6月我院收治的60例BM患儿作为研究对象,抽取患儿脑脊液和血液进行分离培养实验,并将分离出的病原菌进行药敏实验,分析病原菌的分布特征及耐药性。结果研究的60例中,分离出的病原菌有62株,其中革兰阳性菌有40株(64.52%),革兰阴性菌有22株(35.48%),肺炎链球菌占比例为32.26%,大肠埃希菌占比例为25.81%,这两种病原菌明显高于其他种类的病原菌,差异具有统计学意义(P<0.05)。肺炎链球菌对青霉素、红霉素的耐药率超过了85%;大肠埃希菌对氨苄西林的耐药率超过了80%,但大肠埃希菌,金黄色葡萄球菌,流感嗜血杆菌,无乳链球菌对万古霉素的耐药性分别为18.75%、12.50%、16.67%、25.00%,说明在BM使用万古霉素更有疗效。结论儿童BM病原菌以肺炎链球菌,大肠埃希菌为主,要作出快速准确的病原学诊断,根据药敏实验结果,进行合理的抗生素治疗,在必要的时候进行抗生素的联合治疗,提高治愈率。Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with bacterial meningitis （BM）. Methods Sixty children with bacterial meningitis admitted to our hospital between May 2006 and June 2015 were selected as subjects. The isolation and culture of cerebrospinal fluid （CSF） and blood were performed in children. The sus- ceptibility test was carried out to analyze the distribution and drug resistance of pathogenic bacteria. Results There were 62 strains isolated in the 60 cases, 40 of which were Gram-positive bacteria （64. 52% ）, and 22 were Gram-negative bacteria （35.48%）. Streptococcus pneumoniae accounted for 32. 26% and bacteria 25.81%. These two pathogens were much more prevalent than oth- er types of pathogens, and the difference was statistically significant （P〈0. 05 ）. The resistance rate of streptococcus pneumoniae to penicillin and erythromycin was more than 85 %. The resistance rate of escherichia coli to ampicillin was over 80%. However, the resistance rates of E. coli, Staphylococcus aureus, Haemophilus influenzae and Streptococcus agalactia to vancomycin were 18. 75% ,12. 50% ,16. 67%, and 25.00% respectively, indicating that the clinical use of bacterial meningitis vancomycin was more effective. Conclusion The pathogenic bacteria of Streptococcus pneumoniae and Escherichia coli are the main pathogens of BM in children. Clinicians should make a quick and accurate diagnosis of the pathogens. Antibiotics should be chosen according to the results of antimicrobial susceptibility test. The combination of antibiotics should be used to improve the cure rate if necessary.

关 键 词：细菌性脑膜炎 脑脊液 耐药性 病原菌 

分 类 号：R515.2[医药卫生—内科学]