婴儿大肠埃希菌脑膜炎的临床特征及其并发症的危险因素  

Clinical features of Escherichia coli meningitis in infants and risk factors for its complications

作　　者：鲁成刚 朱蒙权 张解宁 葛禾佳 方声 李军胜 许会卿[7] 徐志伟[2] 陈理华[8] 郑吉善[7] 陈英虎[1] LU Chenggang;ZHU Mengquan;ZHANG Jiening;GE Hejia;FANG Sheng;LI Junsheng;XU Huiqing;XU Zhiwei;CHEN Lihua;ZHENG Jishan;CHEN Yinghu(Department of Infectious Diseases,Children’s Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China;Department of General Pediatrics,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Pediatrics,Jiaxing Maternity and Child Health Care Hospital,Jiaxing 314050,China;Department of Pediatrics,Jiaxing Second Hospital,Jiaxing 314001,China;Department of Pediatric Internal Medicine,Taizhou Hospital Affiliated to Wenzhou Medical University,Taizhou 317000,China;Department of Neonatology,Lishui Maternal and Child Health Hospital,Lishui 323000,China;Department of Pediatrics,Ningbo Women and Children’s Hospital,Ningbo 315012,China;Department of Neonatology,Children’s Hospital of Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院感染科,浙江杭州310052 [2]温州医科大学附属第二医院育英儿童医院普儿科,浙江温州325027 [3]嘉兴市妇幼保健院儿内科,浙江嘉兴314050 [4]嘉兴市第二医院儿科,浙江嘉兴314001 [5]温州医科大学附属台州医院儿内科,浙江台州317000 [6]丽水市妇幼保健院新生儿科,浙江丽水323000 [7]宁波市妇女儿童医院儿科,浙江宁波315012 [8]浙江大学医学院附属儿童医院新生儿科,浙江杭州310052

出　　处：《温州医科大学学报》2023年第8期621-627,共7页Journal of Wenzhou Medical University

基　　金：中央引导地方科技发展专项基金(S20A0003)。

摘　　要：目的:分析婴儿大肠埃希菌脑膜炎的临床特征及其并发症的危险因素,为其诊治及改善预后提供循证学依据。方法:收集2019年1月1日至2021年4月30日浙江省52家医院住院的918例社区获得性细菌性脑膜炎患儿的临床资料,选择脑脊液和(或)血培养为大肠埃希菌阳性的62例细菌性脑膜炎患儿,对其临床特点、分离菌株药物敏感性及并发症的危险因素进行回顾性分析。结果:62例患儿年龄为1~228日龄,≤28日龄43例(69.4%),>28日龄~≤3月龄16例(25.8%),>3月龄3例(4.8%);23例(37.1%)有基础疾病。所有患儿均有发热,15例(24.2%)发热时间>1周。病初颅外感染性疾病依次为脓毒血症(47例,75.81%)、消化道感染(20例,32.3%)、呼吸道感染(14例,22.6%)。40例(64.5%)出现并发症,以硬膜下积液/积脓(19例,30.6%)最为常见。单因素分析发现,有并发症患儿年龄、首次脑脊液白细胞计数和微量总蛋白量高于无并发症患儿,差异有统计学意义(P<0.05);多因素Logistic回归分析发现,年龄>28日龄(OR=5.730,95%CI=1.216~27.001,P<0.05)、首次脑脊液微量总蛋白>1271.5 mg/L(OR=5.473,95%CI=1.473~20.329,P<0.05)是大肠埃希菌脑膜炎患儿并发症的危险因素。大肠埃希菌对氨苄西林(55.0%)、阿莫西林(55.6%)耐药率高,对头孢呋辛、头孢曲松、头孢噻肟中等耐药,对美罗培南、亚胺培南、厄他培南完全敏感。结论:大肠埃希菌脑膜炎主要发生于≤3月龄的小婴儿,并发症发生率高,年龄>28日龄、首次脑脊液微量总蛋白>1271.5 mg/L是并发症的重要危险因素;临床医师应尽早使用有效抗菌药物,及早发现并发症,早期干预治疗,从而改善预后。Objective:To analyze the clinical characteristics and risk factors for complications of Escherichia coli meningitis in infants,and to provide evidence-based reference for its diagnosis,treatment and improvement of prognosis.Methods:The clinical data of 918 children with community-acquired bacterial meningitis admitted into 52 hospitals in Zhejiang Province from January 1,2019 to April 30,2021 were collected.A total of 62 children with bacterial meningitis whose cerebrospinal fluid and(or)blood culture was positive for Escherichia coli were selected.The clinical characteristics,drug sensitivity of isolated strains and risk factors for complications were retrospectively analyzed.Results:Of 62 patients who were aged 1-228 days,43 cases≤28 days(69.4%),16 cases>28 days≤3 months(25.8%),and 3 cases>3 months(4.8%);23 cases(37.1%)had underlying diseases.All patients had fever,with 15 cases(24.2%)having fever for more than 1 week.The initial extracranial infectious diseases were sepsis(47 cases,75.81%),gastrointestinal infection(20 cases,32.3%),and respiratory tract infection(14 cases,22.6%).Complications occurred in 40 cases(64.5%),with subdural fluid/pus accumulation being the most common(19 cases,30.6%).Univariate analysis showed that the age,first cerebrospinal fluid white blood cell count and micro total protein content of children with complications were higher than those without complications,with significant difference(P<0.05).Multivariate Logistic regression analysis showed that age>28 days(OR=5.730,95%CI=1.216-27.001,P<0.05)and first cerebrospinal fluid micro total protein>1271.5 mg/L(OR=5.473,95%CI=1.473-20.329,P<0.05)were risk factors for complications in children with Escherichia coli meningitis.Escherichia coli was highly resistant to ampicillin(55.0%)and amoxicillin(55.6%),moderately resistant to cefuroxime,ceftriaxone and cefotaxime,and completely sensitive to meropenem,imipenem and ertapenem.Conclusion:Escherichia coli meningitis mainly occurs in infants younger than 3 months old,with a high incidence

关 键 词：大肠埃希菌脑膜炎 临床特征 并发症 婴儿 

分 类 号：R725[医药卫生—儿科]