60例化脓性脑膜炎病原菌及药敏性分析  

Analysis of pathogenic bacteria and drug sensitivity in 60 cases of purulent meningitis

作　　者：韩玉华[1] 周俐红[1] 路燕[1] 张伟[1] HAN Yuhua;ZHOU Lihong;LU Yan;ZHANG Wei(Xinriang Central Hospital,Xinriang 453002,Henan,China)

机构地区：[1]河南省新乡市中心医院,河南新乡453002

出　　处：《中国病原生物学杂志》2024年第6期699-702,共4页Journal of Pathogen Biology

摘　　要：目的分析化脓性脑膜炎病原菌分布和耐药特点,为临床诊治提供依据。方法选取于本院就诊化脓性脑膜炎患者60例。患者入院24 h内收集脑脊液标本。将样本进行鉴定,并对临床常用的抗生素进行药敏试验。采用PCR技术对肺炎链球菌耐药基因进行检测。采用荚膜肿胀试验确定血清分型。结果共计检出60株病原菌,其中革兰阳性菌占65%(39/60),革兰阴性菌占35%(21/60)。肺炎链球菌、金黄色葡萄球菌和大肠埃希菌是主要致病菌。肺炎链球菌对青霉素、红霉素、阿奇霉素、阿莫西林、阿莫西林/克拉维酸、头孢曲松、头孢噻肟、头孢吡肟和左旋氧氟沙星耐药率分别为47.06%、88.24%、88.24%、35.29%、0.00%、17.65%、29.41%、23.53%和5.88%,未对阿米卡星、利奈唑胺、万古霉素产生耐药性。大肠埃希菌对哌拉西林、四环素、阿莫西林/克拉维酸、头孢曲松、头孢噻肟、头孢吡肟和左氧氟沙星耐药率分别为66.67%、44.44%、22.22%、55.56%、66.67%、33.33%和11.11%,对哌拉西林/他唑巴坦、阿米卡星、亚胺培南、美罗培南和替加环素未产生耐药性。17株肺炎链球菌中14株携带ermB基因,2株携带ermC基因,4株携带mefA基因,4株携带msrD基因和7株携带tetM基因。共计检出5个血清分型,分别为6B型5株(29.41%,5/17),19F型4株(23.53%,4/17),23F型2株(11.76%,2/17),19A型和14型各检出1株(5.88%,1/17)。结论本次研究中化脓性脑膜炎致病菌以肺炎链球菌主,革兰阳性菌对红霉素和阿奇霉素耐药程度较高,其中ermB基因检出率较高与对大环内酯类抗生素耐药有关,本次区肺炎链球菌血清型以6B型和19F型为主。Objective The distribution and drug resistance characteristics of pathogenic bacteria in purulent meningitis were analyzed,to provide a basis for clinical diagnosis and treatment.Methods 60 patients with purulent meningitis were selected,who admitted in our hospital.The cerebrospinal fluid samples were collected from patients within 24 hours of admission.The samples were identified,and drug sensitivity were test on commonly used antibiotics in clinical practice.PCR technology was used to detect the resistance genes of S.pneumoniae.The serum was typed by capsule swelling test.Results A total of 60 pathogenic bacteria were detected,of which Gram positive bacteria accounted for 65%(39/60)and Gram negative bacteria accounted for 35%(21/60).The resistance rates of S.pneumoniae to penicillin,erythromycin,azithromycin,amoxicillin,amoxicillin/clavulanic acid,ceftriaxone,cefotaxime,cefepime,and levofloxacin were 47.06%,88.24%,88.24%,35.29%,0.00%,17.65%,29.41%,23.53%,and 5.88%,respectively.There was no resistance to amikacin,linezolid,or vancomycin.The resistance rates of E.coli to piperacillin,tetracycline,amoxicillin/clavulanic acid,ceftriaxone,cefotaxime,cefepime,and levofloxacin were 66.67%,44.44%,22.22%,55.56%,66.67%,33.33%,and 11.11%,respectively.There was no resistance to piperacillin/tazobactam,amikacin,imipenem,meropenem,and tigecycline.Among the 17 strains of S.pneumoniae,14 strains carried the ermB gene,2 strains carried the ermC gene,4 strains carried the mefA gene,4 strains carried the msrD gene,and 7 strains carried the tetM gene.A total of 5 serotypes were detected,including 5 strains of 6B type(29.41%,5/17),4 strains of 19F type(23.53%,4/17),2 strains of 23F type(11.76%,2/17),1 strain of 19A type and 1 strain of 14 type each(5.88%,1/17).Conclusion In this study,S.pneumoniae was the main pathogen causing purulent meningitis.Gram positive bacteria had a high degree of resistance to erythromycin and azithromycin.The high detection rate of ermB gene was related to resistance to macrolide antibiotics.The serotyp

关 键 词：化脓性脑膜炎 肺炎链球菌 耐药 血清型 

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