發(fā)布時間：2018-06-07 15:26

  本文選題：化膿性腦膜炎 + 腦脊液�。� 參考：《臨床兒科雜志》2016年07期

【摘要】：目的了解兒童腦脊液培養(yǎng)的常見病原菌分布和體外耐藥模式。方法回顧分析2007年1月至2014年12月住院患兒腦脊液細菌培養(yǎng)結果。細菌鑒定和藥敏試驗采用法國生物梅里埃的Vitek系統(tǒng),部分菌株藥敏試驗采用紙片擴散法。結果研究期間23 099例患兒至少送檢腦脊液1次,分離出細菌671株,陽性率2.9%。其中革蘭陽性菌579株(86.3%),革蘭陰性菌92株(13.7%),排名前5位細菌依次為:凝固酶陰性葡萄球菌399株(58.9%)、微球菌37株(5.5%)、肺炎鏈球菌34株(5.1%)、大腸埃希菌32株(4.8%)、屎腸球菌26株(3.9%)。連續(xù)8年的腦脊液培養(yǎng)陽性率呈下降趨勢(趨勢χ~2=10.410,P?=0.001),凝固酶陰性葡萄球菌年度陽性率呈下降趨勢(趨勢χ~2=31.200,P0.001),大腸埃希菌年度陽性率則呈上升趨勢(趨勢χ~2=4.786,P=0.029)。凝固酶陰性葡萄球菌對苯唑西林耐藥率達79.8%,未發(fā)現(xiàn)耐利奈唑胺和耐萬古霉素的凝固酶陰性葡萄球菌;微球菌對萬古霉素敏感率為100%;肺炎鏈球菌對青霉素耐藥率為77.8%,對萬古霉素敏感率為100.0%;大腸埃希菌對哌拉西林/他唑巴坦和美洛培南的敏感率為100.0%。結論腦脊液細菌培養(yǎng)陽性率低,凝固酶陰性葡萄球菌、微球菌、肺炎鏈球菌、大腸埃希菌、屎腸球菌是主要菌種。臨床應根據(jù)培養(yǎng)陽性菌株、藥敏結果合理選擇抗菌藥物。
[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.
【作者單位】： 浙江大學醫(yī)學院附屬兒童醫(yī)院;杭州師范大學;
【分類號】：R446.14

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