437例新生儿化脓性脑膜炎临床分析  

Clinical Analysis of 437 Cases of Neonatal Purulent Meningitis

作　　者：刘凌 邓春[2] Liu Ling;Deng Chun(Chongqing Jialing Hospital,Chongqing 400030,China;Children’s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆嘉陵医院,重庆400030 [2]重庆医科大学附属儿童医院,重庆400014

出　　处：《儿科药学杂志》2021年第9期21-24,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨新生儿化脓性脑膜炎临床特点及病原菌特征。方法:回顾性分析重庆医科大学附属儿童医院2007-2018年437例新生儿化脓性脑膜炎住院患儿的临床资料。结果:发热201例(46.0%),抽搐75例(17.2%),颅内压增高45例(10.3%),肌张力异常127例(29.1%)。脑脊液培养阳性率6.9%,其中G^(-)菌6例(6/11),G^(+)菌5例(5/11)。血培养阳性率27.2%,其中G^(-)菌70例(58.8%),G^(+)菌49例(41.2%),以大肠埃希菌和葡萄球菌最为常见,大肠埃希菌对氨苄西林、头孢噻肟、头孢曲松耐药率>70.0%,对哌拉西林耐药率22.5%,而对碳青霉烯类抗生素敏感;葡萄球菌对万古霉素、利奈唑胺均敏感,但对其他药敏检测药物均出现较高耐药率(57.1%~100%)。2007-2012年血培养检出G^(-)菌10例,G^(+)菌9例;2013-2015年血培养检出G^(-)菌28例,G^(+)菌21例;2016-2018年血培养检出G^(-)菌32例,G^(+)菌19例。结论:新生儿化脓性脑膜炎临床症状不典型;病原学以大肠埃希菌和葡萄球菌常见,血培养检出革兰阴性菌阳性比例呈上升趋势,大肠埃希菌对碳青霉烯类抗生素和哌拉西林敏感,葡萄球菌对万古霉素、利奈唑胺敏感,但对其他抗生素耐药率高。Objective:To probe into the clinical features and pathogenic bacteria characteristics of neonatal purulent meningitis.Methods:Clinical data of 437 neonates with purulent meningitis in Children’s Hospital of Chongqing Medical University from 2007 to 2018 were analyzed retrospectively.Results:There were 201 cases(46.0%)of fever,75 cases(17.2%)of convulsion,45 cases(10.3%)of increased intracranial pressure and 127 cases(29.1%)of abnormal muscle tone.The positive rate of cerebrospinal fluid culture was 6.9%,including 6 cases(6/11)of G^(-)bacteria and 5 cases(5/11)of G^(+)bacteria.The positive rate of blood culture was 27.2%,including 70 cases(58.8%)of G^(-)bacteria and 49 cases(41.2%)of G^(+)bacteria,Escherichia coli and Staphylococcus were the most common.The drug resistance rate of E.coli to ampicillin,cefotaxime and ceftriaxone was>70.0%,the drug resistance rate to piperacillin was 22.5%,and E.coli was sensitive to carbapenems.Staphylococcus was sensitive to vancomycin and linezolid,which showed higher rug resistance(from 57.1%to 100%)to other drugs.From 2007 to 2012,10 cases of G^(-)bacteria and 9 cases of G^(+)bacteria were detected in blood culture.From 2013 to 2015,28 cases of G^(-)bacteria and 21 cases of G^(+)bacteria were detected in blood culture.From 2016 to 2018,32 cases of G^(-)bacteria and 19 cases of G^(+)bacteria were detected in blood culture.Conclusion:The clinical symptoms of purulent meningitis in neonates are atypical.Pathogenesis is common with E.coli and Staphylococcus,and the proportion of Gram-negative bacteria detected by blood culture is in an increasing tendency.E.coli is sensitive to carbapenem and piperacillin,while Staphylococcus is sensitive to vancomycin and linezolid,yet has a higher rate of resistance to other antibiotics.

关 键 词：化脓性脑膜炎 血培养 脑脊液培养 革兰阴性菌 新生儿 

分 类 号：R722.1[医药卫生—儿科]