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《南京师大学报（自然科学版）》[ISSN:1001-4616/CN:32-1239/N]

Issue:

2018年04期

Page:

115-

Research Field:

·生命科学·

Publishing date:

Info

Title:

Bacteriological Features and Poor Short-term Prognostic Factors forPediatric Bacterial Meningitis in Nanjing Area

Author(s):

Liu Xuemei¹; Wu Peng²; Zhou Jin¹; Tan Hua¹; Chang Lin¹; Yu Hanqing¹; Xu Fei¹

(1.Department of Clinical Laborator,Nanjing Children’s Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)(2.Department of Infectious Diseases,Nanjing Children’s Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)

Keywords:

bacterial meningitis; pathogen; clinical characteristic; drug resistance; prognosis

PACS:

R72

DOI:

10.3969/j.issn.1001-4616.2018.04.018

Abstract:

To analysis the species distribution of pathogens,the drug resistance pattern in vitro and the short-term prognostic factors for pediatric bacterial meningitis(BM),and to provide reference for clinical diagnosis and treatment of BM,clinical and pathogenic data of inpatients with pathogens identified BM were collected from Jan 2015 to Dec 2017 and then the cases were classified into two groups,namely good prognosis group(n=160)and poor prognosis group(n=45)according to Glasgow clinical outcome scores. Clinical characteristics of BM were compared between two groups and the independent risk factors for poor prognosis were explored by Logistic regression. There were 125 Gram-positive(G⁺)strains(61.0%)and 80 Gram-negative(G^-)strains(39.0%)in 205 cases,in which Coagulase negative staphylococcus(CNS),Escherichia coli,Streptococcus pneumoniae,Acinetobacter Bauman,Enterobacter cloacae,and Enterococcus faecium were the most frequently isolated pathogens. In recent three years,there was a significant downward trend of G⁺ strains and upward trend of G^- strains in the annual constituent ratio(χ²=6.100,P=0.047). G⁺ strains had relatively high sensitivity rates to rifampin,the resistance rates to clindamycin,gentamicin and compound sulfamethoxazole were over 50.0%,and those to penicillin G,oxacillin and erythromycin were over 80.0%,however,no linezolid and vancomycin resistant G⁺ strains were found. G^- strains had relatively high sensitivity rates to amikacin,imipenem,cefepime and levofloxacin,the resistance rates to ampicillin/sulbactam,aztreonam and compound sulfamethoxazole were over 50.0%,and those to ampicillin and cefuroxime were over 80.0%. Poor prognosis of BM was associated with younger children,unequal pupil size in both eyes,complications,and the abnormal index of hemoglobin,CSF-WBC,CSF-protein,CSF-glucose,C-reactive protein,initial procalcitonin,brain CT/MRI and electroencephalogram(P<0.05). Logistic regression analysis showed that 95% confidence intervals of unequal pupil size in both eyes and CSF-WBC>500×10⁶/L were 1.397～184.122 and 1.013～8.319,respectively(Both P<0.05). In Nanjing area,there are many kinds of BM pathogenic bacteria and the drug resistance that are serious. The main pathogenic bacteria of BM is G⁺ strains,but there is an upward trend in the annual constituent ratio of G^- strains in recent three years. Unequal pupil size in both eyes and CSF-WBC>500×10⁶/L are the independent risk factors for poor short-term prognosis in children with BM.

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