| 摘要: |
| 目的：探讨苏州地区细菌性脑膜炎患儿病原构成及耐药性。方法：回顾性分析2011-2019年在苏州大学附属儿童医院住院的细菌性脑膜炎患儿脑脊液培养结果，总结不同年龄段患儿的病原分布特点及耐药情况。结果：535例患儿中，162例细菌培养阳性，阳性率为30.3%；菌种主要为肺炎链球菌42株（25.9%）、无乳链球菌39株（24.1%）、大肠埃希菌36株（22.2%）等。1~3岁组阳性率为53.6%，均高于其他各年龄组（P均<0.05）。革兰阴性杆菌组的患儿年龄与革兰阳性球菌组、革兰阳性杆菌组比较差异均有统计学意义（P<0.05），年龄越小越容易感染革兰阴性杆菌。新生儿组以无乳链球菌和大肠埃希菌为主，29 d~1岁组病原种类较多，多见肺炎链球菌、无乳链球菌和大肠埃希菌，而>1岁患儿以肺炎链球菌为主。脑脊液培养前使用过抗菌药物的患儿细菌检出阳性率低于未使用过抗菌药物的患儿（P<0.05）。药敏结果显示，肺炎链球菌及无乳链球菌对万古霉素、利奈唑胺敏感率达100%；肺炎链球菌对青霉素的耐药率较高，为85.7%；大肠埃希菌对氨苄西林、头孢噻肟、头孢曲松的耐药率分别为66.7%、53.8%、38.7%，对碳青霉烯类（美罗培南、亚胺培南、厄他培南）、酶抑制剂复合制剂（哌拉西林/他唑巴坦、头孢哌酮/舒巴坦）敏感性达100%。结论：肺炎链球菌、无乳链球菌和大肠埃希菌为苏州地区儿童细菌性脑膜炎的常见病原菌，不同年龄组患儿检出的细菌构成不同，临床应根据脑脊液培养、药敏试验结果合理选择抗菌药物。 |
| 关键词: 细菌性脑膜炎 病原菌 耐药性 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2022.12.007 |
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| 基金项目:苏州市儿童感染性疾病精准诊治重点实验室,编号SZS2020310。 |
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| Pathogens Distribution and Drug Resistance of Children with Bacterial Meningitis in Suzhou from 2011 to 2019 |
| Wu Jiahui, Tian Jianmei, Kong Xiaoxing, Cheng Fangfang |
| (Children’s Hospital of Soochow University, Jiangsu Suzhou 215003, China) |
| Abstract: |
| Objective: To investigate the pathogens distribution and drug resistance of children with bacterial meningitis in Suzhou. Methods: Retrospective analysis was performed on cerebrospinal fluid culture results of children with bacterial meningitis hospitalized in Children’s Hospital of Soochow University from 2011 to 2019, pathogens distribution and drug resistance in children at different ages were summarized. Results: Among 535 children, 162 strains were positive, with a positive rate of 30.3%. The main pathogens were Streptococcus pneumoniae (42 strains, 25.9%), Streptococcus agalactiae (39 strains, 24.1%) and Escherichia coli (36 strains, 22.2%). The positive rate of 1 to 3 years old group was 53.6%, higher than that of other age groups (P<0.05). The age of children in the Gram-negative bacilli group was statistically significantly different from that in the Gram-positive cocci group and the Gram-positive bacilli group (P<0.05), indicating that children with younger age were more likely to be infected with Gram-negative bacilli. S. agalactiae and E. coli were the main bacterial pathogens in the neonatal group, the pathogens of infants aged from 29 d to 1 year were various, mainly S. pneumoniae, S. agalactiae and E. coli, while S. pneumoniae was the predominant pathogen in children aged more than 1 year. The positive rate of bacteria detection in children who used antibiotics before cerebrospinal fluid culture was lower than that in children who did not (P<0.05). S. pneumoniae and S. agalactiae were 100% sensitive to vancomycin and linezolid. The resistance rate of S. pneumoniae to penicillin was 85.7%. The resistance rates of E. coli to ampicillin, cefotaxime and ceftriaxone were 66.7%, 53.8% and 38.7%, respectively. The sensitive rates of E. coli to carbapenems (meropenem, imipenem and ertapenem) and enzyme-added antibiotics (piperacillin/tazobactam and cefoperazone/sulbactam) were 100%. Conclusion: S. pneumoniae, S. agalactiae and E. coli are the common pathogens for bacterial meningitis in children in Suzhou. The distribution of bacteria varies in different age groups. Antibiotics should be reasonably chosen according to the results of bacterial culture and drug sensitivity tests. |
| Key words: bacterial meningitis pathogens drug resistance children |
