目的：探讨儿童中枢神经系统感染脑脊液病原菌的构成及耐药性。方法全自动细菌鉴定仪VITEK32进行细菌鉴定和药敏实验并结合 K-B 药敏实验法,根据美国临床和实验室标准协会(CLSI)标准进行结果判读。结果住院患儿中枢神经系统感染脑脊液标本1990份共分离病原菌181株,检出阳性率9.1%(181/1990)。细菌检出率95.0%(172/181),真菌检出率5.0%(9/181),其中肺炎链球菌19.3%(35/181),表皮葡萄球菌18.8%(34/181),大肠埃希菌17.1%(31/181)。3种主要细菌的分离率较高,主要集中分布在1岁以内患儿。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶(ESBLs)检出率较高,分别为41.9%(13/31)和50.0%(3/6)。主要的革兰阴性细菌大肠埃希菌和肺炎克雷伯菌对厄它培南和亚胺培南耐药率为0,未发现耐万古霉素的革兰阳性细菌。结论对中枢神经系统感染患儿脑脊液进行培养和药敏实验,根据药敏结果合理选用抗生素,对降低细菌的耐药和提高药物的敏感性,临床合理使用抗菌药物有指导作用。%Objective To analyze pathogen distribution and antimicrobial resistance of bacilli from cerebrospinal fluid among children with central nervous system infection. Methods The VITEK32 was used for bacteria identification.The bacterial susceptibility testing was done by Kirby-Bauer method.The antimicrobial susceptibility was determined according to CLSI standard.Results 1 990 cerebrospinal fluid of children with central nervous system infection were detected.181 strains were isolated,and the detection rate was 9.1% (181/1 990).The isolated rate of bacteria was 95.0% (1 72/181 ) and fungus rate was 5.0% (9/181 ).The rate of Streptococcus pneumonia, Staphylococcus epidermidis and Escherichia coli were 1 9.3% (35/181 ),18.8% (34/181 ),1 7.1% (31/181 ), respectively.The isolated rate of ESBLs of Escherichia coli and Klebsiella pneumoniae were 41.9%(13/31)and 50.0%(3/6).The isolated rate of tri-predominant bacteria were the highest in pediatric patients with one year of age.The drug of resistant rates of fundamental gram-negative bacteria including Escherichia coli and Klebsiella pneumoniae to ertapenem and imipenem were 0.The resistance to vancomycin of gram-positive bacteria was not detected.Conclusion It is important to apply clinical antibiotics for increasing antibiotics susceptibility on the basis of cultivation results and antimicrobial resistance of bacilli from cerebrospinal fluid among children with central nervous system infection.
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