儿童细菌性脑膜炎病原学特点及用药分析  

Pathogenic characteristics in children with bacterial meningitis and analysis of drug use

作　　者：李三妮[1] 段坤峰[2] 王玉庆 张古英[1] LI Sanni;DUAN Kunfeng;WANG Yuqing;ZHANG Guying(Department of Pharmacy,Children's Hospital of Hebei Province, Shijiazhuang 050031 , China;Department of Pharmacy, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China;Department of Laboratory ,Children's Hospital of Hebei Province, Shijiazhuang 050031 , China)

机构地区：[1]河北省儿童医院药剂科,石家庄050031 [2]河北医科大学第三医院药剂科,石家庄050051 [3]河北省儿童医院医学检验科,石家庄050031

出　　处：《中国临床药学杂志》2019年第5期358-362,共5页Chinese Journal of Clinical Pharmacy

基　　金：河北省医学科学研究重点课题计划(编号20150568)

摘　　要：目的分析儿童细菌性脑膜炎的病例特点,了解目前儿科临床分离细菌种类分布及对抗菌药物的耐药性变化。方法回顾性分析2015年1月至2018年12月出院诊断为细菌性脑膜炎患儿,共1 436例。结果患儿发病年龄为(1.86±3.03)岁,0.5 h^13岁;发病较多的月份是6月至9月;住院天数(19.80±11.03)d;主要合并症为肺部感染、新生儿败血症、脓毒血症、贫血、上呼吸道感染和心肌酶异常等;全部患儿的治愈率为78.20%,好转率为19.36%,放弃率为2.37%,死亡率为0.07%;276例患儿检出阳性,阳性率为19.22%,其中共检出革兰阳性菌183株,革兰阴性菌101株。前3位的病原菌为肺炎链球菌、表皮葡萄球菌和大肠埃希菌。肺炎链球菌对万古霉素100%敏感,革兰阴性菌仍对亚胺培南、美罗培南、哌拉西林他唑巴坦、氯霉素和阿米卡星等高度敏感。结论革兰阳性菌仍是细菌性脑膜炎的主要致病菌。细菌性脑膜炎的预后与病原菌、机体合并感染的部分及是否及早有效应用抗菌药物治疗密切相关。根据患儿病情应及早进行脑脊液检查,选择强有力的抗菌药物治疗,必要时联合用药。AIM To retrospectively analyze the bacterial of child bacterial meningitis, and explore its characteristics. To investigate the changing pattern of common bacterial pathogens and their drug resistance in the pediatric clinic. METHODS A total of 1 436 patients of definite bacterial meningitis in our hospital were analyzed from January 2015 to December 2018. RESULTS Age of onset in children was 0. 5 h - 13 years, an average age of ( 1.86 ±3.03) years. The months with the most cases were June /July/August/September. Average hospital stay was (19. 80 ±11.03) days. Major complication were lung infection, neonatal septicemia, sepsis, anemia, upper respiratory tract infection and myocardial enzyme abnormality, etc. The cure rate was 78. 20%. The recovery rate was 19. 36%. Abandonment rate was 2. 37%. Mortality was 0. 07%. A total of 276 pathogen strains were detected from the 1 436 samples, including 183 Gram-positive strains, 101 Gram -negative strains, with a positive rate of 19. 22%. The three most frequently isolated pathogens were Streptococcus pneumonia, Staphylococcus epidermidis and Escherichia coli. No Staphylococcus resistant to vancomycin were found. Gram-negative bacilli had relatively high sensitivity rates to imipenem, meropenem , piperacillin/tazobactam, chloramphenicol and amikacin. CONCLUSION Gram-positive cocci are the predominant pathogens for child bacterial meningitis over the past 4 years. The detected pathogens develop high resistance to commonly used antimicrobial agents. It is imperative to perform cerebrospinal fluid examination in suspected cases and apply sensitive antibacterial drugs in time or drug combination therapy when necessary.

关 键 词：儿童 细菌性脑膜炎 病原学 抗菌药物 

分 类 号：R446.5[医药卫生—诊断学] R742.9[医药卫生—临床医学]