[1]刘雪梅,吴鹏,周 晋,等.南京地区儿童细菌性脑膜炎病原菌特征和近期预后危险因素[J].南京师范大学学报(自然科学版),2018,41(04):115.[doi:10.3969/j.issn.1001-4616.2018.04.018]
　Liu Xuemei,Wu Peng,Zhou Jin,et al.Bacteriological Features and Poor Short-term Prognostic Factors forPediatric Bacterial Meningitis in Nanjing Area[J].Journal of Nanjing Normal University(Natural Science Edition),2018,41(04):115.[doi:10.3969/j.issn.1001-4616.2018.04.018]
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南京地区儿童细菌性脑膜炎病原菌特征和近期预后危险因素()
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《南京师范大学学报》（自然科学版）[ISSN:1001-4616/CN:32-1239/N]

卷:
第41卷
期数:
2018年04期
页码:
115
栏目:
·生命科学·
出版日期:
2018-12-31

文章信息/Info

Title:
Bacteriological Features and Poor Short-term Prognostic Factors forPediatric Bacterial Meningitis in Nanjing Area
文章编号:
1001-4616(2018)04-0115-05
作者:
刘雪梅1; 吴鹏2; 周 晋1; 谈 华1; 常 林1; 于汉卿1; 徐 飞1
(1. 南京医科大学附属儿童医院检验科,江苏 南京 210008)(2.南京医科大学附属儿童医院感染科,江苏 南京 210008)
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)
关键词:
细菌性脑膜炎; 病原菌; 临床特点; 耐药性; 预后
Keywords:
bacterial meningitis; pathogen; clinical characteristic; drug resistance; prognosis
分类号:
R72
DOI:
10.3969/j.issn.1001-4616.2018.04.018
文献标志码:
A
摘要:
了解南京地区儿童细菌性脑膜炎(BM)病原菌种类、分布、体外耐药模式及近期预后危险因素,为临床BM诊治提供参考. 收集2015年 1月-2017 年 12月诊治的病原菌明确的BM患儿资料. 根据Glasgow 临床结局评分将患儿分成预后良好组(n=160)和预后不良组(n=45),比较两组间BM病原菌特征和分析近期预后不良的独立危险因素. 205例病原菌中革兰氏阳性(G+)菌125株(61.0%),以凝固酶阴性葡萄球菌(CNS)、肺炎链球菌和屎肠球菌为主; 革兰氏阴性(G-)菌80株(39.0%),以大肠埃希菌、鲍曼不动杆菌和阴沟肠杆菌为主. 近3年,G+菌和G-菌年度构成比分别呈下降和上升趋势(χ2=6.100,P=0.047). G+菌对利福平较敏感,超过50.0%对克林霉素、庆大霉素和复方新诺明等耐药,超过80.0%对青霉素G、苯唑西林和红霉素等耐药,但未发现耐利奈唑胺和万古霉素的G+菌株; G-菌对阿米卡星、亚胺培南、头孢吡肟和左氧氟沙星较敏感,超过50.0%对氨苄西林/舒巴坦、安曲南和复方新诺明等耐药,超过80.0%对氨苄西林和头孢呋辛等耐药. BM近期预后不良与患儿年龄偏小、瞳孔大小不一、并发症以及血红蛋白、CSF-WBC、CSF-蛋白质、CSF-葡萄糖、C-反应蛋白、降钙素原、颅脑CT/MRI或脑电图等指标异常有关(P<0.05); 多因素Logistic回归分析显示,瞳孔大小不一和CSF-WBC>500×106/L 的95% CI分别为1.397～184.122和1.013～8.319(P均<0.05). 近3年南京地区儿童BM病原菌种类较多、耐药性严重. 病原菌以 G+菌为主,但G-菌年度构成比有上升趋势,瞳孔大小不一和CSF-WBC>500×106/L是近期预后不良的独立危险因素.
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.

参考文献/References:

[1] AGRAWAL S,NADEL S. Acute bacterial meningitis in infants and children:epidemiology and management[J]. Paediatr drugs,2011,13(6):385-400.
[2]GUO L Y,ZHANG Z X,WANG X,et al. Clinical and pathogenic analysis of 507 children with bacterial meningitis in Beijing,2010-2014[J]. Int J Infect Dis,2016,50:38-43.
[3]PENG H L,HU Y,CHEN H J,et al. Risk factors for poor prognosis in children with refractory purulent meningitis and the discharge criteria[J]. Journal of infection and public health,2018,11(2):238-242.
[4]HOURI H,PORMOHAMMAD A,RIAHI S M,et al. Acute bacterial meningitis in Iran:systematic review and meta-analysis[J]. Plos One,2017,12(2):e0169617.
[5]王汉斌,华春珍,李建平,等. 2007-2014 年儿童脑脊液培养病原菌分布及耐药性分析[J]. 临床儿科,34(7):533-537.
[6]母丽媛,旷凌寒,周伟,等. 成都地区儿童细菌性脑膜炎的病原菌分布及耐药分析[J]. 中国妇幼保健,2015,30(30):5175-5177.
[7]胡伟,王秉圆,李继安,等. 儿童化脓性脑膜炎病原菌分布及其耐药性分析[J]. 临床儿科,2017,35(5):366-368.
[8]强光峰,胡冰,刘钢. 婴儿屎肠球菌脑膜炎一例[J]. 中华传染病,2016,34(12):692-694.
[9]KANIK-YUKSEK S,GüHAN B,TEZER H,et al. Invasive pneumococcal disease in two non-vaccinated pediatric cases:pleural empyema and bacteremia[J]. Mikrobiyoloji bülteni,2015,49(3):446-453.
[10]áLVAREZ-MARíN R,GIL-BERMEJO J M,CISNEROS J M. Epidemiology and treatment of multidrug-resistant acinetobacter baumannii[J]. Current treatment options in infectious diseases,2014,6(4):409-424.
[11]洪琳亮,洪舒婷,黄欢欢,等. 儿童化脓性脑膜炎近期不良预后的危险因素分析[J]. 福建医科大学学报,2015,49(4):252-255.
[12]LIN W L,CHI H,HUANG F Y,et al. Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis[J]. J Microb Immunol Infect,2016,49(5):723-728.

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备注/Memo

备注/Memo:
收稿日期:2018-05-18.
通讯联系人:徐飞,副主任技师,研究方向:临床微生物检验. E-mail:feixu1975@126.com
更新日期/Last Update: 2018-12-30