颅内感染患者脑脊液病原菌培养结果分析

目的分析颅内感染患者脑脊液病原菌培养结果,为临床诊断及治疗提供参考。方法回顾性收集2017年1月-2019年1月本院收治的颅内感染患者60例临床资料,分析病原菌培养的结果。结果60例颅内感染患者共培养出68株病原菌,其中以革兰阳性菌为主(41株),占60.29%,其次是革兰阴性菌(27株)占39.71%。革兰阳性菌中以金黄色葡萄球菌(14株)和表皮葡萄球菌(11株)为主,分别占20.59%、16.18%;革兰阴性菌以肺炎克雷伯菌(9株)和不动杆菌(6株)为主,分别占8.82%、5.88%。结论颅内感染患者脑脊液病原菌以革兰阳性菌为主,尤其是金黄色葡萄球菌、表皮葡萄球菌,革兰阴性菌中以肺炎克雷伯菌和不动杆菌为主。     

细菌性脑膜炎患儿脑脊液病原菌分布及药敏实验分析

目的 探讨细菌性脑膜炎患儿脑脊液病原菌分布和药敏实验结果,为临床治疗提供依据。方法 采集86例细菌性脑膜炎患儿的脑脊液标本,行病原菌培养和药敏实验,进行多重耐药菌筛查及耐药情况分析。结果 86份脑脊液标本中,共分离出病原菌94株,其中革兰氏阴性菌38株,占40.43%,以大肠埃希菌、肺炎克雷伯菌为主;革兰氏阳性菌56株,占59.57%,以肺炎链球菌、金黄色葡萄球菌为主。大肠埃希菌对氨苄西林(92.86%)、磺胺甲噁唑(78.57%)耐药率较高;肺炎克雷伯菌对氨苄西林(100%)、头孢噻肟(91.67%)耐药率较高,对环丙沙星(8.33%)耐药性低;肺炎链球菌对红霉素(100%)耐药率较高,对氨苄西林、万古霉素、环丙沙星及庆大霉素无耐药性;金黄色葡萄球菌对氨苄西林(100%)耐药率较高,对庆大霉素、万古霉素、头孢噻肟及氯霉素无耐药性。结论 细菌性脑膜炎患儿感染的病原菌情况较复杂,不同病原菌对抗菌药物具有不同程度的敏感性,临床可根据药敏实验结果对症给药,规范使用抗生素,减少耐药菌株的产生。     

脑脊液置换治疗细菌性脑膜炎临床观察

细菌性脑膜炎(主要包括化脑和结脑)是较常见的中枢神经系统感染性疾病,若不及时有效地控制感染,则多因出现诸多并发症而预后凶险。但由于血脑屏障的影响,全身应用抗生素很难在颅内达到有效的杀菌浓度,而鞘内用药也有一定的局限性。为此,我科从1995年1月至1997年1月采用脑脊液置换治疗细菌性脑膜炎20例,效果明显,现报告如下。 1 临床资料 1.1 一般资料 本组男12例,女8例,年龄12～50岁,平均26岁。其中化脓性脑膜炎15例(流脑6例),结核性脑膜炎5例(4例脑膜炎型,1例为脑膜脑炎型)。其中合并化脓性中耳炎2例,牙周脓肿1例,颅底骨折1例,肺脓肿1例,合并肺结核3例。病程3天至3个月不等,平均12天。     

小儿化脓性脑膜炎脑脊液酶学检测结果评价

小儿化脓性脑膜炎在儿科颅内感染性疾病中属于发病率较高的疾病之一。目前常规实验室采用的脑脊液 (CSF)生化、常规检查及细菌涂片培养 ,检验方法存在着灵敏度不高、培养阳性率低等问题。当脑膜感染或脑组织受损时 ,引起 CSF中某些酶浓度升高 [1,2 ]。我们检测了 CSF中乳酸脱氢酶 (LD)和门冬氨酸氨基转移酶 (AST) ,现将结果报告如下。材料和方法一、病例1 .化脑组　收集 1 997年 1 2月～ 1 998年 1月间由临床初步诊断为化脓性脑膜炎患儿的腰穿CSF,同时参考 CSF生化、常规检查及细菌涂片培养的结果 ,获得 9份阳性标本。小儿年龄为 8d…     

脑脊液TNF在儿童中枢神经系统感染的临床意义

中枢神经系统感染一直是危害儿童健康的常见感染疾病，具较高的病死率和致残率，其中细菌性脑膜炎和病毒性脑炎占绝大多数。为探讨肿瘤坏死因子（TNF）在中枢神经系统感染发病中的可能作用机制，作者检测比较了细菌性脑膜炎和病毒性脑炎患儿血清和脑脊液中TNF的水平变化，并总结分析如下。     

小儿化脓性脑膜炎脑脊液酶学检测结果评价

小儿化脓性脑膜炎在儿科颅内感染性疾病中属于发病率较高的疾病之一。目前常规实验室采用的脑脊液(CSF)生化、常规检查及细菌涂片培养,检验方法存在着灵敏度不高、培养阳性率低等问题。当脑膜感染或脑组织受损时,引起CSF中某些酶浓度升高［1,2］。我们检测了CSF中乳酸脱氢酶(LD)和门冬氨酸氨基转移酶(AST),现将结果报告如下。材料和方法 一、病例 1.化脑组收集1997年12月～1998年1月间由临床初步诊断为化脓性脑膜炎患儿的腰穿CSF,同时参考CSF生化、常规检查及细菌涂片培养的结果,获得9份阳性标本。小儿年龄为8 d～4岁。其中4例患儿有明确细菌学诊断,分别为都柏林沙门菌、肺炎链球菌、大肠杆菌和嗜血流感杆菌b型感染。 2.对照组收集由临床初步诊断为高热惊厥、发热待查或抽搐待查患儿的腰穿CSF,同时潘氏球蛋白定性试验(潘氏试验)阴性,细胞计数＜15×106/L,蛋白和葡萄糖数值均在正常范围内,共计15份标本。年龄58 d～10岁。     

结核性脑膜炎205例治疗前后脑脊液生化结果分析

目的探讨结核性脑膜炎治疗前后脑脊液生化结果的意义。方法回顾性分析我院205例结核性脑膜炎患者的脑脊液检查资料。结果 205例患者经抗痨等综合治疗后脑脊液压降低180例（87.8%）,蛋白降低153例（78.1%）,葡萄糖升高132例（64.4%）,氯化物升高136例（66.3%）,治疗后好转175例（85.4%）,死亡7例（3.4%）,未愈自动出院23例（11.2%）。结论脑脊液检查对结核性脑膜炎诊断是一种非常必要的重要依据,对结核性脑膜炎的早期诊断、判断疗效、指导临床用药有较高的价值,简便易行的脑脊液检查是结脑早期诊断及病情监护的良好措施。     

Pediatric Lumbar Puncture and Cerebrospinal Fluid Analysis

Background

Lumbar puncture (LP) is a commonly performed procedure in pediatrics. Accurate analysis of cerebrospinal fluid (CSF) profile is essential in diagnosing and managing a variety of infectious and inflammatory conditions involving the brain, meninges, and spinal cord. It can also provide useful diagnostic information in the evaluation of possible subarachnoid hemorrhage and demyelinating syndromes, and aid in the diagnosis and management of pseudotumor cerebri.

Objectives

To review anatomic, physiologic, and pathologic aspects of performing pediatric lumbar puncture and CSF analysis.

Discussion

Although still a commonly performed procedure in the outpatient setting, effective vaccines to prevent invasive infection due to Streptococcus pneumoniae and Haemophilus influenzae type b have greatly reduced pediatric bacterial meningitis rates due to these pathogens, resulting in decreased opportunity for physician-trainees to perfect this important skill (among nonneonates) during the 3 years of supervised residency training. Success in performing pediatric LP is augmented by a thorough understanding of medical aspects related to this procedure. This article discusses technical aspects involved in successfully performing a lumbar puncture to obtain CSF, and interpreting a CSF profile in children.

Conclusion

A thorough understanding of anatomic, physiologic, and pathologic considerations regarding performing lumbar puncture and CSF analysis can augment success in diagnosing a variety of potentially serious pediatric conditions.     

病毒性脑炎患儿脑脊液人类鼻病毒检测的价值

目的 了解儿童病毒性脑炎的病原体,建立快速、特异检测鼻病毒的方法,探讨病毒性脑炎与鼻病毒的相关性。方法 收集2012年1月～12月全年期间收住在汕头大学医学院第二附属医院儿科重症监护室出现发热、惊厥症状的患儿脑脊液标本169份,应用巢式RT-PCR扩增脑脊液标本的鼻病毒核酸,对阳性结果进行核酸序列测定和同源性分析。结果 巢式RT-PCR总共检测出39份鼻病毒阳性样本,总阳性检出率为23.1%; 人类鼻病毒(HRV)感染的儿童中年龄在5岁以下的占87.6%; 7～9月份HRV阳性检出率较高; 序列分析显示39例HRV检测阳性标本中HRV-A型18例(46.1%,18/39),HRV-B型7例(17.9%,7/39),HRV-C型14例(35.9%,14/39); 28例病毒性脑炎有8例检出HRV,其中3例为HRV-C。结论 建立的巢式RT-PCR可以检测到脑脊液标本中的鼻病毒片段,并且HRV-A,B和C三型均有检出,结合临床症状可认为HRV可能是病毒性脑炎的病原体之一。     

Accuracy and Test Characteristics of Ancillary Tests of Cerebrospinal Fluid for Predicting Acute Bacterial Meningitis in Children with Low White Blood Cell Counts in Cerebrospinal Fluid

Objectives: To determine whether ancillary tests of cerebrospinal fluid (CSF), specifically, the total protein concentration, glucose concentration, and percent neutrophils, provide information for diagnosing acute bacterial meningitis among children with low white blood cell (WBC) count in CSF. Methods: The authors retrospectively reviewed CSF from children aged 1 month to 18 years undergoing lumbar puncture at Children's Hospital in Boston from 1993 to 1999. Data were supplemented with CSF test results obtained from children with 0–30 WBCs/mm³ in CSF diagnosed with acute bacterial meningitis at the same institution from 1984 to 1992. For each test, the incremental value of ancillary tests was estimated by calculating indices of performance such as the area under receiver operator characteristic curves (AUC) and interval likelihood ratios that are relatively insensitive to disease prevalence. Results: Among children with 0–30 WBCs/mm³ in CSF who met study criteria, acute bacterial meningitis was identified in ten of 7,701 (0.1%) for the period from 1993 to 1999 and supplemented with 11 additional cases for the period from 1984 to 1992. AUC values for ancillary tests were 0.61 for total protein concentration, 0.69 for glucose concentration, and 0.90 for percent neutrophils. Interval likelihood ratios were unremarkable for mildly abnormal test results. In contrast, interval likelihood ratios for markedly abnormal test results were higher: 22 for total protein concentration >120 mg/dL, 57 for neutrophils >75%, 15 for glucose concentration <20 mg/dL, and 20 for glucose concentration >120 mg/dL. Conclusions: When markedly abnormal, results of CSF total protein concentration, glucose concentration, and percent neutrophils have value for diagnosing acute bacterial meningitis, even among children with a low WBC count in CSF.     

Serum and Cerebrospinal Fluid Pharmacokinetics of Intravenous and Oral Lamivudine in Human Immunodeficiency Virus-Infected Children

We studied the pharmacokinetics of intravenously and orally administered lamivudine at six dose levels ranging from 0.5 to 10 mg/kg of body weight in 52 children with human immunodeficiency virus infection. A two-compartment model with first-order elimination from the central compartment was simultaneously fitted to the serum drug concentration-time data obtained after intravenous and oral administration. The maximal concentration at the end of the 1-h intravenous infusion and the area under the concentration-time curve after oral and intravenous administration increased proportionally with the dose. The mean clearance of lamivudine (± standard deviation) in the children was 0.53 ± 0.19 liter/kg/h (229 ± 77 ml/min/m² of body surface area), and the mean half-lives at the distribution and elimination phases were 0.23 ± 0.18 and 2.2 ± 2.1 h, respectively. Clearance was age dependent when normalized to body weight but age independent when normalized to body surface area. Lamivudine was rapidly absorbed after oral administration, and 66% ± 25% of the oral dose was absorbed. Serum lamivudine concentrations were maintained above 1 μM for ≥8 h of 24 h on the twice daily oral dosing schedule with doses of ≥2 mg/kg. The cerebrospinal fluid drug concentration measured 2 to 4 h after the dose was 12% (range, 0 to 46%) of the simultaneously measured serum drug concentration. A limited-sampling strategy was developed to estimate the area under the concentration-time curve for concentrations in serum at 2 and 6 h.     

Cerebrospinal Fluid Penetration of Amikacin

Adult volunteers underwent a single lumbar puncture 1 to 8.5 h after one 7.5-mg/kg intramuscular amikacin injection. Eighteen showed no detectable drug in cerebrospinal fluid; six had concentrations <0.5 μg/ml.     

Concentrations of Cefpirome in Cerebrospinal Fluid of Children with Bacterial Meningitis after a Single Intravenous Dose

A single intravenous dose of cefpirome, 50 mg/kg, was administered to 15 children with bacterial meningitis 24 to 48 h after initiation of standard antibiotic and steroid therapy. Cefpirome concentrations in serum and cerebrospinal fluid were determined at selected time intervals. The mean (standard deviation) peak concentration in cerebrospinal fluid (n = 5) was 10.8 (7.8) μg/ml. Drug concentrations in cerebrospinal fluid above the MIC for Streptococcus pneumoniae at which 90% of the isolates were inhibited were found 2, 4, and 8 h after the dose of cefpirome was given. The penetration of cefpirome into cerebrospinal fluid compares favorably with that of other extended-spectrum cephalosporins and suggests that this agent would be useful in the therapy of childhood meningitis, including cases caused by drug-resistant S. pneumoniae.     

儿童病毒性脑炎急性期脑脊液细胞学特点及临床意义

目的：探讨儿童病毒性脑炎急性期脑脊液细胞学（CSFC）的特点和诊断价值。方法选择收治的62例病毒性脑炎急性期患儿作为观察组,同期儿童非中枢感染性疾病患儿62例作为对照组,比较两组患儿的脑脊液细胞学异常检出率、常规、生化特点。结果观察组单核吞噬细胞检测率与对照组比较,差异无统计学意义（P〉0.05）,观察组浆细胞、激活型单核细胞和转化型淋巴细胞的检测率均显著高于对照组,差异均有统计学意义（P〈0.05）,观察组CSFC异常检测率显著高于常规检查,差异具有统计学意义（P〈0.05）,观察组CSFC生化检查异常检测率显著高于对照组,差异具有统计学意义（P〈0.05）。结论儿童病毒性脑炎患儿急性期采用脑脊液细胞学检查检测率高,具有重要的诊断价值。     

Bactericidal Activity of Vancomycin in Cerebrospinal Fluid

Intraventricular application of vancomycin is an effective therapeutic regimen for the treatment of shunt-associated staphylococcal ventriculitis. We examined the in vitro activity of vancomycin at high concentrations against Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis ATCC 12228 in human cerebrospinal fluid samples. Time-kill curves revealed equal efficacies for concentrations of 10, 100, and 300 microg/ml, and incubation times of 24 to 48 h were needed to achieve a 3 log(10) reduction of viable bacteria. A concentration of 5 microg/ml showed a slightly lower activity, but this difference was not significant. In an infant who was successfully treated for shunt-associated ventriculitis due to S. epidermidis by once-daily local administration of vancomycin (3 mg for 2 days and 5 mg for 4 days [0. 5 to 0.8 mg/kg of body weight]) the in vivo kill kinetics were similar to those for the in vitro results. These results support time-dose regimens that provide trough vancomycin levels of 5 to 10 microg/ml.     

腰大池持续引流治疗外伤性顽固性脑脊液漏17例分析

目的 探讨持续腰大池引流治疗外伤性顽同性脑脊液漏的疗效.方法 回顾性分析2001年1月～2008年12月经持续腰大池引流治疗的17例外伤性顽固性脑脊液漏患者的临床资料.结果 采用腰大池持续引流脑脊液治疗外伤顽固性脑脊液漏17例,结果渗漏口在10～14d内愈合,无复发及严重并发症.结论 腰大池持续引流治疗外伤性顽固性脑脊液漏创伤小、操作简单、安全有效.     

2017年广东省东莞地区儿童血培养病原菌分布及耐药性分析

目的了解广东省东莞地区儿童患者血培养病原菌临床分布 和耐药性情况。方法对2017年1～12月东莞市23家二级甲等及以 上参加细菌耐药监测的医疗机构的住院儿童患者血培养病原菌分布和耐药性进行回顾性分析 。结果广东省东莞地区儿童患者血培养全年共分离病原菌979株, 其中革兰阳性菌541株(占55.26％),前三位病原菌为凝固酶阴性葡萄球菌(CNS)、金黄色葡 萄球菌和肺炎链球菌,分别占41.98％,3.57％和2.86％;革兰阴性菌431株(占44.02％ ),前三位病原菌为黏质沙雷菌、大肠埃希菌和斯氏假单胞菌,分别占13.68％,11.44 ％和5.31％;真菌7株(占0.72％)。药敏结果显示革兰阳性葡萄球菌对青霉素和氨苄西 林耐药率高,SCN耐药严重;革兰阴性杆菌对氨苄西林耐药严重,头孢哌酮/舒巴坦、哌拉西 林/他唑巴坦和碳青霉烯类敏感率较高。结论广东省东莞地区儿童 血培养以革兰阳性球菌为主,其中SCN占优势且耐药严重。应加强对儿童患者血培养病原菌 的耐药性监测,掌握其耐药特点以有效控制感染并减少多重耐药菌的产生。