| 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（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；新生儿化脓性脑膜炎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。 |
| 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 |
| DOI：doi:10.13407/ j.cnki.jpp.1672.108X.2021.09.007 |
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| 基金项目: |
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| Clinical Analysis of 437 Cases of Neonatal Purulent Meningitis |
| Liu Ling1, Deng Chun2 |
| (1. Chongqing Jialing Hospital, Chongqing 400030, China; 2. Children’s Hospital of Chongqing Medical University, Chongqing 400014, China) |
| Abstract: |
| 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. |
| Key words: purulent meningitis blood culture cerebrospinal fluid culture Gram-negative bacteria neonates |
