新生儿化脓性脑膜炎病原学及预后分析

摘要

目的 探讨新生儿化脓性脑膜炎的病原学特点和预后情况.方法 回顾性分析35例新生儿化脓性脑膜炎患儿的临床特点、实验室检查、病原学及治疗转归.结果 35例患儿中血培养29例检出病原菌,检出阳性率82.9%,其中G-菌为16例(55.2%),G+菌13例(44.8%),大肠埃希菌15例、阴沟肠杆菌1例、无乳链球菌8例、李斯特菌3例、溶血葡萄球菌2例.脑脊液培养18例检出病原菌,并且与血培养结果一致,检出阳性率51.4%,其中G-菌12例(66.7%),均为大肠埃希菌,G+菌6例(33.3%),均为无乳链球菌.35例患儿治愈23例(65.7%),好转8例(22.9%),死亡2例(5.7%),因严重并发症放弃治疗2例(5.7%).15例大肠埃希菌感染者治愈6例(40%)、好转5例(33.3%)、死亡2例(5.7%)、因严重并发症放弃2例(5.7%).结论 新生儿化脓性脑膜炎病原学以G-菌为主,大肠埃希菌感染率高,并且预后差.%Objective To explore the etiological characteristics and the prognosis of neonatal purulent meningitis. Methods A retrospective review was performed and a total of 35 cases of neonatal purulent meningitis were identified. The clinical information including clinical characteristics、auxiliary examination、etiology and therapeutic outcome were analyzed. Results Blood culture findings were positive in 29 patients(82.9%) ,with 16( 55.2%) cases the pathogens were Gram-negative bacteria and 13(44.8%) were Gram-positive bacteria.The isolated pathogens of 29 cases were Escherichia coli(15 cases) 、Enterobacter cloacae(1 case)、Streptococcus agalactiae(8 cases)、Listeria bacteria(3 cases)、Staphylococcus haemolyticus(2 cases). Cerebrospinal fluid culture findings were positive in 18 patients(51.4%) with the consistent results of the blood culture, with 12(66.7%) cases the pathogens were Gram-negative bacteria and 6(33.3%)were Gram-positive bacteria. The isolated pathogens of 18 cases were Escherichia coli(12 cases)、Streptococcus agalactiae(6 cases). Of the 35 patiens,23 were cured(65.7%),8 improved(22.9%),2 died(5.7%),2 uncured with severe complications(5.7%).Of the 15 patients with meningitis caused by Escherichia coli,6 were cured(40%),5 improved (33.3%),2 died(13.3%),2 uncured with severe complications(13.3%). Conclusion Gram-negative bacteria are the predominant pathogens of the neonatal purulent meningitis, meningitis cased by Escherichia coli have a high infection rate and poor prognosis.