儿童细菌性脑膜炎病原学及耐药性分析

摘要

目的 了解广州地区儿童细菌性脑膜炎的病原菌分布特点及其耐药状况,为临床进行及时有效治疗提供实验室依据.方法 回顾分析2005年1月-2009年12月广州妇女儿童医疗中心细菌性脑膜炎病例的脑脊液病原菌分离培养结果及其药敏试验情况.结果 5年来共从细菌性脑膜炎患儿的脑脊液标本中检出病原菌335株,其中革兰阳性菌215株(64.18%),革兰阴性菌109株(32.54%),真菌11株(3.28%).主要是凝固酶阴性葡萄球菌(115株,占34.33%)和肺炎链球菌(81株,占24.18%).新生儿及婴儿早期的病原菌主要是凝固酶阴性葡萄球菌.耐甲氧西林凝固酶阴性葡萄球菌发生率达55.65%.葡萄球菌对青霉素、红霉素、克林霉素耐药率超过70%,对万古霉素和利奈唑烷敏感;肺炎链球菌对青霉素耐药率为8.64%,对红霉素和克林霉素耐药率较高(>60%);革兰阴性杆菌对亚胺培南、头孢哌酮/舒巴坦及阿米卡星敏感率较高,但大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶发生率为22.86%和27.59%.结论 儿童细菌性脑膜炎主要病原菌是凝固酶阴性葡萄球菌和肺炎链球菌,早期准确的病原学诊断和及时采用敏感的抗菌药物治疗是降低后遗症发生率和病死率的重要手段.%Objective To determine the distribution and drug resistance of bacteria isolated from children with bacterial meningitis in Guangzhou; as a benchmark rationale for the use of antibiotics. Methods Bacterial sensitive data of children with bacterial meningitis admitted in Guangzhou Women and Children's Medical Center from January 2005 to December 2009 were analyzed. Results A total of 335 organisms were detected from cerebrospinal fluid, including 215 (64.18%) Gram-positive strains, 109 (32.54%) Gram-negative strains and 11 (3.28%) fungal strains. 115 strains (34.33%) of coagulase negative staphylococci (CNS) and 81 (24.18%) strains of Streptococcus pneumoniae were the most common bacteria. About 55.65% of CNS were Methicillin-Resistant ones. No Staphylococcus and Streptococcus pneumoniae was resistant to vancomycin and linezolid. 8.64% of Streptococcus pneumoniae were resistant to penicillin. Extended spectrum beta-lactamases positive rates of Escherichia coli and Klebsiella pneumoniae were 22.86% and 27.59%, respectively. Conclusions CNS and Streptococcus pneumoniae are the predominant organisms of pediatric bacterial meningitis patients. Early diagnosis and treatment are important for better prognosis.