新生儿化脓性脑膜炎病原菌和耐药性及预后危险因素  

Distribution and drug resistance of pathogens isolated from neonates with purulent meningitis and risk factors for prognosis

作　　者：杨磊 刘卫云 胡安辉 胡小华 YANG Lei;LIU Weiyun;HU Anhui;HU Xiaohua(Maternity and Child Care Center of Xinyu,Xinyu,Jiangxi 338000,China;不详)

机构地区：[1]江西省新余市妇幼保健院新生儿科,江西新余338000 [2]新余市人民医院新生儿科,江西新余338000

出　　处：《中华医院感染学杂志》2025年第5期713-717,共5页Chinese Journal of Nosocomiology

基　　金：江西省卫生健康委科技计划基金资助项目(202212252)。

摘　　要：目的分析新生儿化脓性脑膜炎病原菌分布特点、耐药性及预后危险因素。方法选取2020年1月-2022年12月新余市妇幼保健院和新余市人民医院80例新生儿化脓性脑膜炎患儿为研究对象,分析其病原菌分布特点及耐药性检测结果,按照患儿出院时转归,分为预后不良组31例与良好组49例,比较两组临床资料,并分析预后危险因素。结果80例患儿共检出84株病原菌,其中革兰阳性菌占36.90%,主要包括表皮葡萄球菌、溶血葡萄球菌、腐生葡萄球菌与人型葡萄球菌,革兰阴性菌占63.10%,主要包括大肠埃希菌、肺炎克雷伯菌;主要革兰阳性菌对苯唑西林、青霉素、红霉素、头孢西丁和克林霉素耐药率高;主要革兰阴性菌大肠埃希菌对左氧氟沙星、庆大霉素和头孢曲松耐药率高,肺炎克雷伯菌对庆大霉素、左氧氟沙星和妥布霉素耐药率高;不良组昏迷占比、脑脊液总蛋白水平高于良好组(P<0.05),脑脊液糖水平低于良好组(P<0.05);昏迷、高水平脑脊液总蛋白和低水平脑脊液糖为不良预后危险因素(P<0.05)。结论新生儿化脓性脑膜炎患儿病原菌主要为革兰阴性菌,预后不良危险因素主要为昏迷、脑脊液总蛋白及脑脊液糖等,临床应结合病原菌培养及药敏试验合理用药,并对预后危险因素予以加强干预。OBJECTIVE To observe the distribution and drug resistance of pathogens isolated from the neonates with purulent meningitis and analyze the risk factors for prognosis.METHODS A total of 80 neonates with purulent meningitis who were treated in Maternity and Child Care Center of Xinyu and Xinyu People′s Hospital from Jan.2020 to Dec.2022 were recruited as the research subjects.The distribution and drug resistance of the pathogens isolated from the patients were observed.The neonates were divided into the poor prognosis group with 31 cases and the favorable prognosis group with 49 cases according to the treatment outcomes at the discharge from the hospital.The clinical data were compared between the two groups.The risk factors for the prognosis were analyzed.RESULTS Totally 84 strains of pathogens were isolated from 80 children,the gram-positive bacteria accounted for 36.90%,mainly including Staphylococcus epidermidis,Staphylococcus haemolyticus,Staphylococcus saprophyticus and Staphylococcus hominis;The gram-negative bacteria accounted for 63.10%,mainly including Escherichia coli and Klebsiella pneumoniae.The drug resistance rates of the major species of gram-positive bacteria to oxacillin,penicillin,cefoxitin and clindamycin were high.The drug resistance rates of the major species of gram-negative bacteria to levofloxacin,gentamycin and ceftriaxone were high.The drug resistance rates of the K.pneumoniae strains to gentamycin,levofloxacin and tobramycin were high.The proportion of neonates with coma and the total protein level of cerebrospinal fluid were higher in the poor prognosis group than in the favorable prognosis group(P<0.05);the cerebrospinal fluid glucose level of the poor prognosis group was lower than that of the favorable prognosis group(P<0.05).Coma,high level of total protein in cerebrospinal fluid and low level of cerebrospinal fluid glucose were the risk factors for the poor prognosis(P<0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the neonates with pu

关 键 词：新生儿 化脓性脑膜炎 病原菌 耐药性 预后 危险因素 

分 类 号：R722.13[医药卫生—儿科]