儿童脑脊液阳性菌株分布及耐药分析  

Distribution and Drug Resistance of Cerebrospinal Fluid-Positive Strains in Children

作　　者：贾静[1] 郭明发 徐璐[1] 杨俊文 周娟娟 杨俊梅[1] JIA Jing;GUO Mingfa;XU Lu;YANG Junwen;ZHOU Juanjuan;YANG Junmei(Laboratory Department,the Children’s Hospital Affiliated to Zhengzhou University/Henan Children’s Hospital/Zhengzhou Children’s Hospital,Zhengzhou 450003,China;Hematology and Oncology Department,the Children’s Hospital Affiliated to Zhengzhou University/Henan Children’s Hospital/Zhengzhou Children’s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院检验科,河南郑州450003 [2]郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院血液肿瘤科,河南郑州450003

出　　处：《河南医学研究》2024年第1期6-11,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190966);2021年度河南省重点研发与推广专项(科技攻关)(212102310730)。

摘　　要：目的了解儿童脑脊液阳性菌株分布和常用抗菌药物的耐药情况。方法收集2017年1月至2021年12月郑州大学附属儿童医院脑脊液分离菌株,采用基质辅助激光解析电离飞行时间质谱进行病原菌鉴定,凤凰全自动细菌鉴定/药敏检测系统(Phoenix 100)、VITEK 2 Compact全自动微生物鉴定仪(Vitek-2 Compact)和纸片扩散法进行药敏试验,按照美国临床实验室标准化协会标准判读药敏结果,用WHONET 5.6软件进行回顾性耐药性分析。结果314例脑脊液阳性病原菌以革兰阳性菌为主,204株(65.0%)。前五位病原菌依次为凝固酶阴性葡萄球菌92株(29.3%)、肠球菌44株(14.0%)、大肠埃希菌32株(10.2%)、肺炎克雷伯菌21株(6.7%)、肺炎链球菌18株(5.7%)。二、三季度分离菌株数较多,1岁以内婴儿病例最多见,占147株(46.8%)。检出科室以神经外科77株(24.5%)、新生儿内科70株(22.3%)、神经内科46株(14.6%)为主;多重耐药菌检出149株(47.5%),其中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)69株、产超广谱β内酰胺酶肠杆菌(ESBLs)18株、耐碳青霉烯类肠杆菌(CRE)18株;各年龄组、性别、年份之间多重耐药发生率差异无统计学意义(P>0.05),不同科室之间多重耐药的发生率差异有统计学意义(P<0.001)。结论脑脊液阳性病原菌以革兰阳性菌为主,感染主要集中在1岁以内婴儿,对于多重耐药菌株应该重视耐碳青霉烯类肺炎克雷伯菌的检出。Objective To understand the distribution of pathogenic bacteria and resistance to commonly used antimicrobial drugs in the cerebrospinal fluid of children.Methods Cerebrospinal fluid isolates from the Children’s Hospital Affiliated to Zhengzhou University were collected from January 2017 to December 2021,and pathogenic bacteria were identified by matrix assisted laser desorption ionization time flight mass spectrometry,and drug sensitivity experiments were performed by Phoenix 100,Vitek-2 microbiological analyzer and paper diffusion method,and drug sensitivity results were interpreted according to standards of American Association for the standardization of clinical laboratories,and retrospective drug resistance analysis was performed by WHONET 5.6 software.Results A total of 314 pathogenic bacteria were collected from cerebrospinal fluid isolates,with 204(65.0%)predominantly Gram-positive bacteria.The top five pathogens were coagulase-negative Staphylococcus 92 strains(29.2%),Enterococcus 44 strains(14.0%),Escherichia coli 32 strains(10.2%),Klebsiella pneumoniae 21 strains(6.7%),and Streptococcus pneumoniae 18 strains(5.7%)in order.The number of isolated strains was higher in the second and third quarters,and 147 strains(46.8%)were the most common in infants within 1 year of age.The detected departments were mainly neurosurgery 77 strains(24.5%),neonatology 70 strains(22.3%),and neurology 46 strains(14.6%).Multi-drug resistant bacteria were detected 149 strains(47.5%),including 69 strains methicillin-resistant coagulase negative staphylococci(MRCNS),18 strains extended-spectrumβ-lactamase-producing Enterobacteriaceae(ESBLs)and 18 strains carbapenem-resistant Enterobacteriaceae(CRE).There were no significant differences in the incidence of multiple drug resistance among age groups,between genders,or between years(P>0.05),and the incidence of multiple drug resistance was different between different departments(P<0.001).Conclusion The pathogenic bacteria isolated from cerebrospinal fluid were mainly Gram-positiv

关 键 词：儿童 脑脊液 多重耐药菌株 

分 类 号：R446.5[医药卫生—诊断学]