临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (6): 425-.doi: 10.3969 j.issn.1000-3606.2016.06.007

• 综合报道 • 上一篇    下一篇

儿童细菌性脑膜炎95 例病原菌分布和预后分析

彭琼玲1,2, 吴渚1, 刘朵朵2, 陶少华1     

  1. 南方医科大学珠江医院 1. 儿科中心,2. 检验医学部(广东广州 510282)
  • 收稿日期:2016-06-15 出版日期:2016-06-15 发布日期:2016-06-15
  • 通讯作者: 陶少华 E-mail:tsh1987@sina.com
  • 基金资助:
    国家重大科技专项课题(No.2014ZX10004005)

The distribution of pathogens and prognosis in ninety-five children with etiology confirmed bacterial meningitis

PENG Qiongling 1,2, WU Zhu1, LIU Duoduo2, TAO Shaohua1   

  1. The distribution of pathogens and prognosis in ninety-five children with etiology confirmed bacterial meningitis
  • Received:2016-06-15 Online:2016-06-15 Published:2016-06-15

摘要: 目的 了解儿童细菌性脑膜炎(BM)病原菌分布、细菌耐药性、临床特征和预后。方法 回顾分析2011 年1月至2015 年7 月期间住院治疗的病原体明确的BM患儿的临床资料。按出院时结局将患儿分为结局良好和结局不良组。分析比较各组患儿的病原菌分布、细菌耐药性、临床特征及预后。结果 共纳入95 例病原体明确的BM患儿,其中69 例(72.6%)为革兰阳性菌,以肺炎链球菌(43 例,45.3%)占首位;26 例为革兰阴性菌(27.4%),以大肠埃希菌(13 例,13.7%)占首位。肺炎链球菌和大肠埃希菌对青霉素的耐药率均超过了50%。BM患儿神经系统并发症包括硬膜下积液、脑积水、脑实质损伤,以及听力和视力损伤等。多元logistic 回归分析显示,意识障碍、昏迷、脑脊液葡萄糖水平低下是BM患儿出院时不良结局的独立危险因素。结论 儿童BM的病原体以肺炎链球菌和大肠埃希菌为主,对青霉素的耐药率高。BM患儿可出现不同程度的神经系统后遗症,意识改变和异常以及脑脊液葡萄糖水平低下提示患儿出院时不良结局。

Abstract: Objective To explore the distribution of pathogens, bacterial drug resistance, clinical features and prognosis of bacterial meningitis (BM) in children. Methods The clinical data of children diagnosed with BM during January 2011 to July 2015 were retrospectively analyzed. Children were divided into good outcome group and poor outcome group by the outcome at discharge. The distribution of pathogens, bacterial drug resistance, clinical features, and prognosis were analyzed among different groups. Results There were included 95 children diagnosed with BM,. among whom 69 (72.6%) children had Grampositive bacterial infections with predominant Streptococcus pneumonia (43 cases, 45.3%) and 26 (27.4%) children had Gramnegative bacterial infections with predominant Escherichia coli (13 cases, 13.7%). More than 50% Streptococcus pneumonia and Escherichia coli were resisted to penicillin. The neurological complications in children with BM included subdural effusions, hydrocephalus, cerebral parenchyma injury, and hearing and visual impairment, et.al. Multivariate logistic regression analysis showed that consciousness, coma, and low level of glucose in cerebrospinal fluid were the independent risk factors for adverse outcome at discharge. Conclusion Streptococcus pneumonia and Escherichia coli were the predominant pathogens in children with BM with high resistance rate to penicillin. BM children may have varying degrees of neurological sequelae. The unconsciousness and low level of glucose in cerebrospinal fluid were associated with unfavorable outcomes at discharge.