广州地区儿童患者脑脊液分离病原菌构成及耐药特征  

Composition and Drug Resistance of Pathogenic Isolates from CSF Culture of Pediatric Patients in Guangzhou

作　　者：黄莲芬[1,2] 周珍文 钟华敏[1] 谢永强[1] 关小珊[1] 陈晓光 李华 HUANG Lian-fen;ZHOU Zhen-wen;ZHONG Hua-min;XIE Yong-qiang;GUAN Xiao-shan;CHEN Xiao-guang;LI Hua(Department of Laboratory Medicine, Guangzhou Women and Children Medical Center Affiliated to Guangzhou Medical University, Guangzhou 510120, China;Department of Pathogen Biology, Southern Medical University, Sohool of Public Health ,Guangdong Provincial Key Laboratory of Tropical Disease, School of Public Health, Southern Medical University, Guangzhou 510515, China;Department of Pathogenic Biology and Experimental Teaching Center of Preventive Medicine, School of Public Health, Southern Medical University, Guangzhou 510515, China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心广州市儿童医院检验科,广州510120 [2]南方医科大学公共卫生学院病原生物学系广东普通高校新发传染病防治重点实验室,广州510515 [3]南方医科大学公共卫生学院病原生物学系暨预防医学实验教学中心,广州510515

出　　处：《现代检验医学杂志》2018年第1期81-85,共5页Journal of Modern Laboratory Medicine

基　　金：广州市卫生局课题(2013A011040022)

摘　　要：目的了解广州地区儿童脑脊液培养分离病原菌构成及药敏特征,为儿童脑膜炎经验治疗提供帮助。方法 2011年1月1日~2015年12月31日5年间,对疑似脑膜炎患儿取脑脊液,按《全国临床检验操作规程》进行病原菌培养、鉴定和药敏,分析病原菌构成和药敏特征。结果共分离132株病原菌,G+菌占57.58%(76/132),G-菌占39.40%(52/132),真菌占3.03%(4/132),主要病原菌为大肠埃希菌(23.48%,31/132),肺炎链球菌(22.73%,30/132),金黄色葡萄球菌(12.12%,16/132)和无乳链球菌(9.85%,13/132)。大肠埃希菌对哌拉西林/他唑巴坦、呋喃妥因、头孢吡肟、丁胺卡那霉素、妥布霉素、亚胺培南、厄他培南和美洛培南无耐药,头孢替坦耐药率3.22%,头孢他啶9.38%,氨曲南12.90%,氨苄西林/舒巴坦、氧氟沙星、环丙沙星、头孢曲松、庆大霉素和头孢唑林约为30%,复方新诺明和氨苄西林60%以上,ESBL阳性率为31.25%。肺炎链球菌对厄他培南无耐药,泰利霉素耐药率5.88%,氯霉素14.71%,头孢曲松17.76%,阿莫西林23.53%,美洛培南32.30%,头孢噻肟35.29%,而对四环素、红霉素、青霉素和复方新诺明都高于70%。金黄色葡萄球菌对利福平、替加环素、喹奴普汀/达福普汀、利奈唑胺和万古霉素无耐药,环丙沙星和庆大霉素耐药率6.25%,复方新诺明12.50%,克林霉素耐药率18.75%,四环素31.25%,红霉素62.50%,对头孢类高于90%,对青霉素近100%,MRSA比率为56.25%。无乳链球菌对青霉素无耐药,环丙沙星耐药率7.69%,氧氟沙星23.08%,对四环素、红霉素、克林霉素耐药率均高于60%。结论广州地区儿童脑脊液培养病原菌主要为大肠埃希菌、肺炎链球菌、金黄色葡萄球菌、无乳链球菌,不同病原菌药敏特征不同,为儿童细菌真菌性脑膜炎的预防、病原学快速诊断和治疗提供指导。Objective To explore the composition and drug resistance characteristics of pathogenic isolates from cerebrospinal fluid（CSF）cultures to facilitate empirical therapy of pediatric patients with meningitis in Guangzhou district.MethodsDuring 2011 Jan 1 st to 2015 Dec 31 st,cerebrospinal fluids were collected from pediatric patients with suspected meningitis for regular culture,identification and drug susceptibility test of pathogenic isolates according to the national clinical laboratory standard operation procedure,followed by analysis of their composition and drug resistance characteristics.Results There were 132 pathogenic isolates from CSF cultures,including Gram-positive strains（39.40%,52/132）,Gram-negative strains（757.58%,6/132）,fungi（3.03%,4/132）,respectively.The main isolates were Escherichia coli（E.coli）（23.48%,31/132）,Streptococcus pneumonia（S.pneumonia）（22.73%,30/132）,Staphylococcus aureus（S.aureus）（12.12%,16/132）and Streptococcus agalactiae（S.agalactiae）（9.85%,13/132）,respectively.E.coli had no resistance to piperacillin/tazobactam,furantoin,cefepime,amikacin,tobramycin,imipenem,ertapenem and meropenem.3.22% resistance rate to cefotetan,9.38% to ceftazidime,12.90% to aztreonam,approximately 30% to ampicillin/sulbactam,ofloxacin,ciprofloxacin,ceftriaxone,gentamycin,cefazolin,over 60% to both sulfamethoxazole and ampicillin,31.25% strains were ESBL positive.S.pneumonia had no resistance to ertapenem,5.88%resistance rate to telithromycin,14.71%to chloromycetin,17.76%to ceftriaxone,23.53%to amoxicillin,32.30%to meropenem,35.29%to cefotaxime,over 70%to tetracycline,erythromycin,penicillin,and sulfamethoxazole.S.aureus had no resistance to rifampicin,tigecycline,quinuprin/dupletin,linezolid and vancomycin,6.25% resistance to ciprofloxacin,6.25% to gentamicin,12.50% to sulfamethoxazole,18.75% resistance to clindamycin,31.25%to tetracycline,62.50% to erythromycin,over 90% to cephalosporins and nearly 100% to penicillin,the rate of MRSA strain was 56.25%.S.agalacti

关 键 词：儿童 细菌 真菌 脑膜炎 耐药性 

分 类 号：R446.14[医药卫生—诊断学]