2007—2014年儿童脑脊液培养病原菌分布及耐药性分析

发布时间：2018-06-07 15:26

本文选题：化脓性脑膜炎 + 脑脊液　；参考：《临床儿科杂志》2016年07期

【摘要】：目的了解儿童脑脊液培养的常见病原菌分布和体外耐药模式。方法回顾分析2007年1月至2014年12月住院患儿脑脊液细菌培养结果。细菌鉴定和药敏试验采用法国生物梅里埃的Vitek系统,部分菌株药敏试验采用纸片扩散法。结果研究期间23 099例患儿至少送检脑脊液1次,分离出细菌671株,阳性率2.9%。其中革兰阳性菌579株(86.3%),革兰阴性菌92株(13.7%),排名前5位细菌依次为:凝固酶阴性葡萄球菌399株(58.9%)、微球菌37株(5.5%)、肺炎链球菌34株(5.1%)、大肠埃希菌32株(4.8%)、屎肠球菌26株(3.9%)。连续8年的脑脊液培养阳性率呈下降趋势(趋势χ~2=10.410,P?=0.001),凝固酶阴性葡萄球菌年度阳性率呈下降趋势(趋势χ~2=31.200,P0.001),大肠埃希菌年度阳性率则呈上升趋势(趋势χ~2=4.786,P=0.029)。凝固酶阴性葡萄球菌对苯唑西林耐药率达79.8%,未发现耐利奈唑胺和耐万古霉素的凝固酶阴性葡萄球菌;微球菌对万古霉素敏感率为100%;肺炎链球菌对青霉素耐药率为77.8%,对万古霉素敏感率为100.0%;大肠埃希菌对哌拉西林/他唑巴坦和美洛培南的敏感率为100.0%。结论脑脊液细菌培养阳性率低,凝固酶阴性葡萄球菌、微球菌、肺炎链球菌、大肠埃希菌、屎肠球菌是主要菌种。临床应根据培养阳性菌株、药敏结果合理选择抗菌药物。
[Abstract]:Objective to investigate the distribution of common pathogens in cerebrospinal fluid culture and drug resistance model in vitro. Methods the results of bacterial culture in cerebrospinal fluid (CSF) of hospitalized children from January 2007 to December 2014 were retrospectively analyzed. The Vitek system of French biological Merier was used for bacteria identification and susceptibility test, and some strains were tested by disk diffusion method. Results during the study period, 23 099 children were examined for cerebrospinal fluid (CSF) at least once, and 671 strains of bacteria were isolated, the positive rate was 2.9%. Among them, 579 strains of Gram-positive bacteria and 92 strains of Gram-negative bacteria were identified as follows: 399 strains of Coagulase negative Staphylococcus, 37 strains of Micrococcus, 34 strains of Streptococcus pneumoniae, 32 strains of Escherichia coli, and 26 strains of Enterococcus faecium, respectively. The top 5 bacteria ranked as follows: 399 strains of Coagulase negative Staphylococcus, 58.9% of Micrococcus, 34 strains of Streptococcus pneumoniae, 32 strains of Escherichia coli, and 26 strains of Enterococcus faecium. For 8 consecutive years, the positive rate of cerebrospinal fluid culture showed a downward trend (蠂 ~ (2) 10. 410 ~ (10) P ~ + P ~ (0.001), the annual positive rate of coagulase negative staphylococci decreased (蠂 ~ (2) 31. 200 P ~ (0.001), and the annual positive rate of Escherichia coli increased (蠂 ~ (2 +) ~ (24) 786 P ~ (0.029). Coagulase-negative staphylococci were found to be resistant to oxacillin (79.8%), and no coagulase-negative staphylococci were found to be resistant to linazolamine and vancomycin. The susceptibility rate of Streptococcus pneumoniae to penicillin was 77.8 and to vancomycin was 100.00.The sensitivity of Escherichia coli to piperacillin / tazobactam and melopenem was 100.0. Conclusion the positive rate of cerebrospinal fluid bacteria culture is low. Coagulase negative Staphylococcus, Micrococcus, Streptococcus pneumoniae, Escherichia coli and Enterococcus faecium are the main strains. Antimicrobial agents should be reasonably selected according to the results of drug sensitivity and culture positive strains in clinic.
【作者单位】：浙江大学医学院附属儿童医院;杭州师范大学;
【分类号】：R446.14

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