摘要
目的对细菌性脑膜炎儿童病例病原菌及耐药检测结果进行分析,为本地区细菌性脑膜炎儿童病例诊断、用药提供依据。方法采用描述流行病学分析方法对甘孜藏族自治州某医院病原检测信息系统病历管理系统中明确诊断为细菌性脑膜炎病例病原菌及耐药检测结果数据进行分析。结果本研究共对2010—2019年甘孜藏族自治州某医院共诊断为细菌性脑膜炎儿童病例355例进行分析,男童199例,女童156例,分别占56.1%、43.9%。病例主要症状为发热持续时间≥3 d(占52.1%)、持续惊厥状态(占54.1%)、抽搐反应(占76.1%)。检出18种致病菌355株,均为单一感染。革兰阳性菌居多,共246株,占69.3%。革兰阴性菌102株,占28.7%。另检出7株真菌菌株,占2.0%。革兰阳性菌以肺炎链球菌(35.2%)、无乳链球菌(13.8%)及金黄色葡萄球菌(13.5%)居多,革兰阴性菌以大肠埃希菌(11.5%)、脑膜炎奈瑟菌(6.2%)及B型流感嗜血杆菌(5.6%)居多。肺炎链球菌对青霉素、氨苄西林、苯唑西林、万古霉素及左氧氟沙星的耐药率均超过80%,对头孢噻肟及莫西沙星敏感(敏感率超过95%)。无乳链球菌未产生严重耐药性,耐药率较高的为红霉素(50.4%)。金黄色葡萄球菌对各种抗生素均具有不同程度的耐药性,对头孢噻肟、头孢西汀、氯霉素、左氧氟沙星及万古霉素较敏感(70.4%~98.0%)。大肠埃希菌对头孢呋辛和头孢唑林的耐药性超过60%,对氯霉素及亚胺培南敏感率均较高(超过94%)。脑膜炎奈瑟菌对大部分抗菌药物具有较高敏感率,对氨苄西林耐药率为27.3%。结论肺炎链球菌和大肠埃希菌是该地区细菌性脑膜炎儿童病例的主要致病菌,对β内酰胺酶类抗生素产生耐药性严重,但仍对三、四代头孢具有较高敏感性。
Objective To analyze the pathogenic bacteria and drug resistance test results of children with bacterial meningitis,so as to provide the basis for the diagnosis and medication of children with bacterial meningitis in this area.Methods Descriptive epidemiological analysis method was used to analyze the pathogenic bacteria and drug resistance test results of bacterial meningitis cases diagnosed in the medical record management system of a hospital in Ganzi Tibetan Autonomous Prefecture.Results This study analyzed 355 children with bacterial meningitis diagnosed between 2010 to2019 in a hospital in Ganzi Tibetan Autonomous Prefecture. Among them,199 were boys and 156 were girls,accounting for 56.1% and 43.9%,respectively. The main symptoms of the cases were fever duration ≥ 3 days(52.1%),status epilepticus(54.1%),and convulsions(76.1%). 355 strains(18 kinds)of pathogenic bacteria were detected,all of them were single infections.246 strains of gram-positive bacteria were detected,accounting for 69.0%,and 102 strains of gram-negative bacteria were detected,accounting for 28.7%,also 7 fungal strains were detected,accounting for 2.0%. Gram-positive bacteria were mostly Streptococcus pneumoniae(35.2%),Streptococcus agalactiae(13.8%)and Staphylococcus aureus(13.5%). Escherichia coli(11.5%),Neisseria intracellularis(6.2%)and Haemophilus influenzae type B(5.6%)were the majority of Gram-negative bacteria. The resistance rate of Streptococcus pneumoniae to penicillin,ampicillin,oxacillin,vancomycin and levofloxacin were all higher than 80%,and the sensitivity rate to cefotaxime and moxifloxacin were higher than 95%. Streptococcus agalactiae did not develop severe drug resistance,but resistance rate to erythromycin was high(50.4%). Staphylococcus aureushadvarying degrees of resistance to various antibiotics,and was relatively more sensitive to cefotaxime,cefoxitin,chloramphenicol,levofloxacin and vancomycin(70.4%-98.0%). The resistance rate of Escherichia coli to cefuroxime and cefazolin were higher than 60%,and the sensitivity rate to chloramphenicol and imipenem were higher than 94%. Neisseria meningitidishadhigh sensitivity rate to most antibacterial drugs,and the resistance rate to ampicillin was 27.3%.Conclusion Streptococcus pneumoniae and Escherichia coli are the main pathogenic bacteria in children with bacterial meningitis in this area. These pathogenic bacteria were highly resistant to β-lactamase antibiotics,but still with high sensitivity rate to third and fourth generation cephalosporins.
作者
刘英
史琴瑶
陈霞
向秋志玛
LIU Ying;SHI Qin-yao;CHEN Xia;XIANGQIU Zhi-ma(People's Hospital of Ganzi Tibetan Autonomous Prefecture,Ganzi 626000,China)
出处
《华南预防医学》
2021年第4期482-486,共5页
South China Journal of Preventive Medicine
基金
四川省卫生和计划生育委员会科研课题(17PJ274)。
关键词
细菌性脑膜炎
病原菌
耐药性
用药安全
Bacterial meningitis
Pathogenic bacteria
Drug resistance
Medication safety
