小儿化脓性脑膜炎病原菌分布及耐药性分析  

Analysis of pathogen distribution and drug resistance of pediatric purulent meningitis

作　　者：刘永林 刘娟 杨慧敏 贺波[3] Liu Yonglin;Liu Juan;Yang Huimin;He Bo(Department of Pediatrics,Shenmu Hospital,Shenmu,Shaanxi 719300,China;Department of Bacteria,Shenmu Hospital,Shenmu,Shaanxi 719300,China;Department of Pediatrics,the Second Hospital of Yulin,Yulin,Shaanxi 719000,China)

机构地区：[1]神木市医院儿科,陕西省719300 [2]神木市医院细菌室,陕西省719300 [3]榆林市第二医院儿科,陕西省719000

出　　处：《中国基层医药》2019年第19期2343-2346,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：陕西省神木县科技项目([2016] 16号22).

摘　　要：目的探讨神木市医院小儿化脓性脑膜炎患儿的细菌学特征及细菌耐药性,为临床合理使用抗生素提供依据。方法对神木市医院2009年6月至2017年3月住院收治的小儿化脓性脑膜炎患儿43例的临床资料及细菌培养结果进行回顾性分析。结果细菌培养及药敏试验阳性共21种:革兰阳性细菌16例(76.19%),革兰阴性杆菌5例(123.81%),其中葡萄球菌感染8例,藤黄/里拉微球菌4例,屎肠球菌1例,肺炎链球菌2例,产单核李斯特菌1例;革兰阴性杆菌均为大肠埃希菌。脑脊液培养革兰染色阳性菌明显高于革兰染色阴性菌,差异有统计学意义(χ2=7.813,P=0.005),脑脊液和血培养培养致病菌的革兰染色阳性例数之间差异无统计学意义(χ2=0.075,P=0.78)革兰阳性球菌普遍对青霉素类、红霉素及克林霉素、一代头孢类抗生素耐药,其中肺炎球菌耐药为100.0%,凝固酶阴性葡萄球菌耐药为87.5%;大肠埃希氏菌对氨苄西林和左氧氟沙星呈现耐药。结论该院儿科中凝固酶阴性葡萄球菌及藤黄/里拉微球菌为导致儿童化脓性脑膜炎的重要致病菌,大肠埃希菌为革兰阴性菌化脓性脑膜炎唯一的致病菌。万古霉素、利奈唑胺对球菌普遍敏感,大肠埃希菌对二代、三代头孢菌素类抗生素敏感。Objective To explore the bacteriological characteristics and bacterial resistance of children with purulent meningitis in the Shenmu Hospital, and to provide evidence for the rational use of antibiotics. Methods We retrospectively analyzed the clinical data and bacterial culture results of 43 children with purulent meningitis in our hospital from June 2009 to March 2017. ResultsThere were 21 types of bacteria culture and drug susceptibility test: Gram-positive bacteria in 16 cases(76.19%), Gram negative bacilli in 5 cases(23.81%), including 8 staph infections, gambogic/lira micrococcus in 4 cases, excrement enterococcus in 1 case, streptococcus pneumoniae in 2 cases, produce mononuclear listeria in 1 case.All the Gram-negative bacilli were Escherichia coli.In cerebrospinal fluid culture, Gram-positive bacteria were significantly higher than Gram-negative bacteria, and the difference was statistically significant(χ2=7.813, P=0.005). There was no statistically significant difference in the number of Gram-positive cases between cerebrospinal fluid and blood culture pathogens(χ2=0.075, P=0.78). Gram positive coccus was generally resistant to penicillin, erythromycin and clindamycin, generation 1 cephalosporin antibiotic, including pneumococcal resistance rate was 100.0%, coagulase negative staphylococcus resistance rate was 87.5%, E.coli was resistant to ampicillin and levofloxacin. Conclusion In the pediatric treatment of our hospital, coagulase negative staphylococcus aureus and vine/Lila micrococcus is the important pathogenic bacteria that causes the children purulent meningitis, Escherichia coli is the only pathogenic bacteria of the Gram-negative bacterial meningitis.Vancomycin and linezolide are sensitive to cocci, and Escherichia coli is sensitive to antibiotics in the second and third generation of cephalosporins.

关 键 词：脑膜炎 细菌性 儿童 病原 抗药性 

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