2014—2018年天津市儿童医院化脓性脑膜炎病原菌分布及耐药性分析
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摘要
目的分析2014—2018年天津市儿童医院化脓性脑膜炎病原菌的分布和耐药性,为临床合理应用抗菌药物提供依据。方法收集2014年1月—2018年12月在天津市儿童医院住院,经脑脊液或血液培养细菌阳性的化脓性脑膜炎患儿121例,统计并分析化脓性脑膜炎病原菌的分布和耐药性。结果化脓性脑膜炎患儿的年龄分布主要为<28 d和28 d～1岁,构成比分别为26.5%、41.3%。共分离出121株病原菌,其中革兰阳性菌85株,占70.2%,主要为肺炎链球菌、表皮葡萄球菌和无乳链球菌;革兰阴性菌36株,占29.8%,主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌。不同年龄段化脓性脑膜炎患儿感染的病原菌不同。肺炎链球菌、表皮葡萄球菌和无乳链球菌均对利奈唑胺和万古霉素完全敏感。肺炎链球菌对左氧氟沙星和莫西沙星也完全敏感,对克林霉素和红霉素的耐药率均高达95.6%;表皮葡萄球菌对苄青霉素、苯唑西林和红霉素的耐药率较高;无乳链球菌对克林霉素和红霉素耐药率较高,对其他抗菌药物均完全敏感。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌均对阿米卡星完全敏感。大肠埃希菌对呋喃妥因也完全敏感,对氨苄西林、哌拉西林的耐药率高达80%;肺炎克雷伯菌对妥布霉素和环丙沙星也完全敏感,对氨苄西林的耐药率高达80.0%;铜绿假单胞菌对头孢他啶、庆大霉素和妥布霉素也完全敏感,对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛、头孢替坦、头孢曲松、复方新诺明和呋喃妥因的耐药率均高达100.0%,对其他抗菌药物的耐药率均为25.0%。结论不同年龄段化脓性脑膜炎患儿感染病原菌不同,临床经验用药时应根据患儿发病年龄和耐药性情况选择不同的抗菌药物,提高治疗的针对性。
Objective To investigate the distribution and drug resistance of pathogenic bacteria from children with purulent meningitis in Tianjin Children's Hospital from 2014 to 2018, and to provide the reference for reasonable use of antibiotics. Methods Children(121 cases) with purulent meningitis with positive bacterial culture by cerebrospinal fluid or blood in Tianjin Children's Hospital from 2014 to 2018 were selected, and the distribution and drug resistance of pathogenic bacteria were analyzed statistically. Results The main age of children with purulent meningitis were <28 d and 28 d — 1 years old with the rate of 26.5% and 41.3%. A total of 121 samples were collected, in which Gram-positive bacteria(85 strains) accounted for 70.2%, and main of them were Streptococcus pneumoniae, Staphylococcus epidermidis, and Streptococcus agalactiae. Gram-negative bacteria were 36 strains(29.8%), and main of them were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The pathogenic bacteria of purulent meningitis in children of different ages are different. S. pneumoniae, S. epidermidis, and S. agalactiae were completely sensitive to linezolid and vancomycin. S. pneumoniae was completely sensitive to levofloxacin and moxifloxacin, and the drug resistance rate against clindamycin and erythromycin were 95.6%. S. epidermidis was resistant to benzylpenicillin, oxacillin, and erythromycin. The drug resistance rate of S. agalactiae against clindamycin and erythromycin was high, and were completely sensitive to other antibiotics. E. coli, K. pneumoniae, and P. aeruginosa were completely sensitive to amikacin. E. coli was also completely sensitive to macrodantin, and the drug resistance rate against ampicillin and piperacillin were 80.0%. K. pneumoniae was also completely sensitive to tobramycin and ciprofloxacin, and the drug resistance rate against ampicillin were 80.0%. P. aeruginosa was also completely sensitive to ceftazidime, gentamicin, and tobramycin, and the drug resistance rate against ampicillin, ampicillin/sulbactam, cefazolin, cefuroxime, cefotetan, ceftriaxone, sulfamethoxazole, and macrodantin were 100.0%, and the drug resistance rate against other antibiotics were 25.0%. Conclusion The pathogenic bacteria of purulent meningitis in children of different ages are different. According to clinical experience, different antimicrobial agents should be selected according to the age of onset and the situation of drug resistance to improve the pertinence of treatment.
Objective To investigate the distribution and drug resistance of pathogenic bacteria from children with purulent meningitis in Tianjin Children's Hospital from 2014 to 2018, and to provide the reference for reasonable use of antibiotics. Methods Children(121 cases) with purulent meningitis with positive bacterial culture by cerebrospinal fluid or blood in Tianjin Children's Hospital from 2014 to 2018 were selected, and the distribution and drug resistance of pathogenic bacteria were analyzed statistically. Results The main age of children with purulent meningitis were <28 d and 28 d — 1 years old with the rate of 26.5% and 41.3%. A total of 121 samples were collected, in which Gram-positive bacteria(85 strains) accounted for 70.2%, and main of them were Streptococcus pneumoniae, Staphylococcus epidermidis, and Streptococcus agalactiae. Gram-negative bacteria were 36 strains(29.8%), and main of them were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The pathogenic bacteria of purulent meningitis in children of different ages are different. S. pneumoniae, S. epidermidis, and S. agalactiae were completely sensitive to linezolid and vancomycin. S. pneumoniae was completely sensitive to levofloxacin and moxifloxacin, and the drug resistance rate against clindamycin and erythromycin were 95.6%. S. epidermidis was resistant to benzylpenicillin, oxacillin, and erythromycin. The drug resistance rate of S. agalactiae against clindamycin and erythromycin was high, and were completely sensitive to other antibiotics. E. coli, K. pneumoniae, and P. aeruginosa were completely sensitive to amikacin. E. coli was also completely sensitive to macrodantin, and the drug resistance rate against ampicillin and piperacillin were 80.0%. K. pneumoniae was also completely sensitive to tobramycin and ciprofloxacin, and the drug resistance rate against ampicillin were 80.0%. P. aeruginosa was also completely sensitive to ceftazidime, gentamicin, and tobramycin, and the drug resistance rate against ampicillin, ampicillin/sulbactam, cefazolin, cefuroxime, cefotetan, ceftriaxone, sulfamethoxazole, and macrodantin were 100.0%, and the drug resistance rate against other antibiotics were 25.0%. Conclusion The pathogenic bacteria of purulent meningitis in children of different ages are different. According to clinical experience, different antimicrobial agents should be selected according to the age of onset and the situation of drug resistance to improve the pertinence of treatment.
引文
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[8]吴春芳,柴树洁,贺维亚.化脓性脑膜炎的病原菌分布与药敏试验分析[J].中华医院感染学杂志, 2015,25(13):2926-2928.
[9]王汉斌,华春珍,李建平. 2007—2014年儿童脑脊液培养病原菌分布及耐药性分析[J].临床儿科杂志, 2016,34(7):535-539.
[10]高静,易招师,钟建民.儿童化脓性脑膜炎164例病原菌及耐药性分析[J].儿科药学杂志, 2013, 19(6):35-38.
[11]雷梅芳,张玉琴,郭静. B族链球菌相关小婴儿化脓性脑膜炎22例临床分析[J].中国实用儿科杂志,2015,30(9):696-700.
[12]赵宁,王萍,魏谋,等.无乳链球菌致新生儿脑膜炎的临床特点分析[J].中国小儿急救医学, 2015,22(3):177-179.
[13]王黎,田丰,陈光琼,等. 2009-2013年重庆地区化脓性脑膜炎患儿病原菌分布和耐药性分析[J].儿科药学杂志, 2013, 19(9):37-42.
[14]陈鸿诗.儿童化脓性脑膜炎病原菌和敏感抗生素的统计分析[J].中国实用神经疾病杂志, 2014, 17(22):61-62.
[15]翟颖如,李朝阳.儿童化脓性脑膜炎病原菌分布及耐药性分析[J].中西医结合心脑血管病杂志, 2017,15(18):2357-2359.
[2]张宏亮,李南,黄振光,等.儿童化脓性脑膜炎药物治疗循证指南的系统评价[J].中国药房, 2016, 27(21):2948-2950.
[3]胡亚美,江载芳.诸福棠实用儿科学[M].第8版.北京:人民卫生出版社, 2015.
[4]喻玮,赵丽娜,李苏娟,等.世界卫生组织控制细菌耐药全球行动计划(草案)编译[J].中华临床感染病杂志, 2015, 8(2):97-101.
[5]叶应妩,王毓三.全国临床检验操作规程[M].第3版.南京:东南大学出版社, 1997:474-548.
[6] Clinical and Laboratory Standards Institute(CLSI).Performance Standards for Antimicrobial Susceptibility Testing[S]. 2012:M100-S22.
[7]罗厚江,陈兰举.小儿化脓性脑膜炎的诊断与治疗[J].中华全科医学, 2018, 16(3):337-338.
[8]吴春芳,柴树洁,贺维亚.化脓性脑膜炎的病原菌分布与药敏试验分析[J].中华医院感染学杂志, 2015,25(13):2926-2928.
[9]王汉斌,华春珍,李建平. 2007—2014年儿童脑脊液培养病原菌分布及耐药性分析[J].临床儿科杂志, 2016,34(7):535-539.
[10]高静,易招师,钟建民.儿童化脓性脑膜炎164例病原菌及耐药性分析[J].儿科药学杂志, 2013, 19(6):35-38.
[11]雷梅芳,张玉琴,郭静. B族链球菌相关小婴儿化脓性脑膜炎22例临床分析[J].中国实用儿科杂志,2015,30(9):696-700.
[12]赵宁,王萍,魏谋,等.无乳链球菌致新生儿脑膜炎的临床特点分析[J].中国小儿急救医学, 2015,22(3):177-179.
[13]王黎,田丰,陈光琼,等. 2009-2013年重庆地区化脓性脑膜炎患儿病原菌分布和耐药性分析[J].儿科药学杂志, 2013, 19(9):37-42.
[14]陈鸿诗.儿童化脓性脑膜炎病原菌和敏感抗生素的统计分析[J].中国实用神经疾病杂志, 2014, 17(22):61-62.
[15]翟颖如,李朝阳.儿童化脓性脑膜炎病原菌分布及耐药性分析[J].中西医结合心脑血管病杂志, 2017,15(18):2357-2359.