住院肺炎患儿不同血清型肺炎链球茵对抗菌药物的耐药性分析

目的 了解当前从我国住院肺炎儿童分离的肺炎链球萧血清型分布和不同血清型菌株对抗菌药物的耐药状况,评估应用疫苗预防儿童肺炎链球菌感染和控制耐药菌传播的价值.方法 肺炎链球菌分离自4家儿童医院呼吸科年龄≤5岁的住院肺炎患儿,采用荚膜肿胀试验进行血清型分析,E试验法检测菌株对8种抗菌药物的敏感性.结果 279株肺炎链球菌中以19F型为最常见(占60.6%),其次为19A(9.7%)、23F(9.3%)和6B(5.4%),7价结合疫苗(PCV7)覆盖率为81.0%,PCV7在青霉素不敏感菌株和敏感菌株中的覆盖率分别为84.2%(202/240)和61.5%(24/39).超过90%的19F和19A型菌株对青霉素不敏感,19F型以中介株为主(71.6%),19A型以耐药株为主(55.6%).结论 住院儿童肺炎病例分离的肺炎链球菌以19F、19A、23F和6B型常见;PCV7覆盖大多数肺炎链球菌和青霉素不敏感菌株,应用该疫苗可有效地预防国内儿童肺炎链球菌感染和阻止耐药菌株传播;非PCV7覆盖的19A型具有较强耐药性.     

2019—2020年160例儿童肺炎链球菌脑膜炎临床流行病学多中心研究

目的 研究中国儿童肺炎链球菌脑膜炎(pneumococcal meningitis, PM)的临床特征、转归和分离菌株肺炎链球菌(Streptococcus pneumoniae, SP)的药物敏感性。方法 回顾性分析2019年1月—2020年12月全国33家三级甲等医院160例<15岁的PM住院患儿的临床信息、实验室资料和微生物学资料。结果 160例PM患儿中,男103例,女57例;年龄15 d至15岁,其中3月龄至<3岁109例(68.1%)。脑脊液培养分离SP菌株95例(59.4%),血培养分离SP菌株57例(35.6%)。脑脊液宏基因组二代测序和脑脊液SP抗原检测阳性率分别为40%(35/87)、27%(21/78)。55例(34.4%)患儿存在1个或多个化脓性脑膜炎高危因素;113例(70.6%)患儿有1个或多个颅外感染病灶;18例(11.3%)有明确基础疾病。临床症状以发热最常见(147例,91.9%),其次是精神萎靡(98例,61.3%)、呕吐(61例,38.1%)等。69例(43.1%)患儿住院期间发生颅内并发症,常见并发症为硬膜下积液和/或积脓(43例,2...     

北京上海广州深圳4家儿童医院肺炎住院患儿肺炎链球菌分离株的血清型分布

目的了解目前从中国住院治疗肺炎患儿分离到的肺炎链球菌的血清型分布，及几种蛋白多糖结合疫苗的覆盖率，评估应用蛋白多糖结合疫苗预防肺炎链球菌感染的价值。方法选择2006年2月16日至2007年2月16日在首都医科大学附属北京儿童医院、复旦大学附属儿科医院、广州市儿童医院和深圳市儿童医院呼吸科住院治疗的肺炎患儿为研究对象，采用一次性吸痰管收集全部病例的呼吸道分泌物标本分离肺炎链球菌，部分患儿进行脑脊液、血液和胸腔积液中肺炎链球菌的分离。采用荚膜肿胀实验进行血清型分析。对4家儿童医院肺炎链球菌分离率和血清型进行分析，率的比较采用χ2检验或Fisher精确概率法。结果 研究期间共纳入2 865例肺炎患儿，2 865例呼吸道吸取物标本中分离到肺炎链球菌279株，其中有2株不同血清型菌株分离自同一病例，分离阳性率为9.7％（278/2 865）。3/8例胸腔积液中分离到肺炎链球菌，其中2例同时从呼吸道分泌物分离到肺炎链球菌，取其一进行血清分型，另1株从胸腔积液中分离的肺炎链球菌复苏失败，未进行血清分型。脑脊液和血液标本中未分离到肺炎链球菌。共有279株肺炎链球菌进行了血清型分析，以19F型最常见（60.6％，169/279），其次为19A（9.7％，27/279）、23F（9.3％，26/279）和6B（5.4％，15/279），上述4种血清型占全部菌株的84.9％（237/279）。肺炎链球菌7价结合疫苗（PCV7）覆盖率为81.0％，但在北京仅为46.0％，明显低于上海（80.0%）、广州(98.4%)和深圳（94.4%）。9价、10价和11价疫苗的覆盖率与PCV7相比并没有明显增加。13价疫苗的覆盖率（92.8％）较PCV7明显升高。结论4家儿童医院肺炎住院患儿分离的肺炎链球菌以19F、19A、23F和6B型常见。PCV7覆盖率为87％     

住院肺炎患儿不同血清型肺炎链球菌对抗菌药物的耐药性分析

目的 了解当前从我国住院肺炎儿童分离的肺炎链球菌血清型分布和不同血清型菌株对抗菌药物的耐药状况,评估应用疫苗预防儿童肺炎链球菌感染和控制耐药菌传播的价值。方法 肺炎链球菌分离自4家儿童医院呼吸科年龄 ≤ 5岁的住院肺炎患儿,采用荚膜肿胀试验进行血清型分析,E试验法检测菌株对8种抗菌药物的敏感性。结果 279株肺炎链球菌中以19F型为最常见（占60.6%）,其次为19A（9.7%）。23F（9.3%）和6B（5.4%）,7价结合疫苗（PCV7）覆盖率为81.0%,PCV7在青霉素不敏感菌株和敏感菌株中的覆盖率分别为84.2%（202/240）和61.5%（24/39）。超过90%的19F和19A型菌株对青霉素不敏感,19F型以中介株为主（71.6%）,19A型以耐药株为主（55.6%）。结论 住院儿童肺炎病例分离的肺炎链球菌以19F。19A。23F和6B型常见;PCV7覆盖大多数肺炎链球菌和青霉素不敏感菌株,应用该疫苗可有效地预防国内儿童肺炎链球菌感染和阻止耐药菌株传播;非PCV7覆盖的19A型具有较强耐药性。     

宏基因组二代测序技术在儿童细菌性脑膜炎病原诊断中的价值北大核心CSCD

目的:探讨宏基因组二代测序技术在儿童细菌性脑膜炎病原诊断中的应用价值。方法:回顾性分析2019年1月1日至2020年12月31日复旦大学附属儿科医院住院诊断为“细菌性脑膜炎”或“化脓性脑膜炎”或“中枢神经系统感染”的189例患儿的病原学检测结果。分别采用培养和宏基因二代测序检测方法检测细菌性脑膜炎患儿的脑脊液,分析2种检测方法病原检出率的差异。根据就诊时患儿年龄分为新生儿组(≤28日龄)和非新生儿组(>28日龄),采用χ^(2)检验进行组间比较。以脑脊液培养为金标准,分析宏基因组二代测序技术在儿童细菌性脑膜炎诊断中的灵敏度和特异度。结果:189例细菌性脑膜炎患儿中男116例、女73例。血和(或)脑脊液培养共检出76株病原菌,其中革兰阳性菌50株(65.8%),检出率较高的致病菌有无乳链球菌18株(23.7%)、大肠埃希菌17株(22.4%)、肺炎链球菌15株(19.7%)。非新生儿组革兰阳性菌感染率高于新生儿组[76.0%(38/50)比50.0%(13/26),χ^(2)=5.24,P=0.020]。48例患儿脑脊液同时送检宏基因二代测序检测和培养,宏基因二代测序检测的病原检出率高于培养方法[20例(41.7%)比12例(25.0%),χ^(2)=16.45,P<0.001]。脑脊液宏基因二代测序和培养检测结果的一致性为79.2%(38/48),其中同时阳性的11例患儿均检出同一种病原菌。以脑脊液培养结果为金标准,宏基因组二代测序技术在细菌性脑膜炎的诊断中的灵敏度为91.7%,特异度为75.0%。结论:宏基因组二代测序技术可提高儿童细菌性脑膜炎的病原检出率,且与脑脊液培养检出结果一致性较高。在诊断细菌性脑膜炎时,尤其在疑似诊断患儿中传统病原学无法明确病原时应尽早完善宏基因二代测序检测。     

儿童肺炎链球菌脑膜炎的临床特点及耐药性分析

目的分析儿科住院患儿肺炎链球菌(SP)脑膜炎的临床特征,同时对培养出的SP菌株进行抗菌药物耐药性分析,以帮助临床早期诊断,合理选用抗菌药物。方法回顾性分析2008年9月至2014年3月收治的14例SP脑膜炎患儿的临床资料并进行耐药性分析。结果 14例SP脑膜炎患儿中,高热13例(93%),抽搐9例(64%),合并败血症7例(50%)。白细胞计数增高11例(79%),CRP增高10例(71%)。所有患儿脑脊液有核细胞计数增高,分类均以中性粒细胞为主,9例(64%)患儿脑脊液蛋白定量结果 1 000 mg/d L。经治疗后10例(71%)患儿痊愈,2例(14%)患儿有后遗症,2例(14%)患儿死亡。SP对青霉素、红霉素、克林霉素、四环素和磺胺耐药率高,均高于60%,对阿莫西林耐药率较低(7%),未发现对万古霉素、氯霉素、左旋氧氟沙星耐药菌株。结论实验室辅助检查指标对于区分SP脑膜炎和其他病原菌引起的脑膜炎无特异性。SP对儿科临床常用抗菌药物耐药情况严重,因此对SP的耐药情况应进行检测,以指导临床用药。     

儿童细菌性脑膜炎病原学及耐药性分析

目的了解广州地区儿童细菌性脑膜炎的病原菌分布特点及其耐药状况,为临床进行及时有效治疗提供实验室依据。方法回顾分析2005年1月—2009年12月广州妇女儿童医疗中心细菌性脑膜炎病例的脑脊液病原菌分离培养结果及其药敏试验情况。结果 5年来共从细菌性脑膜炎患儿的脑脊液标本中检出病原菌335株,其中革兰阳性菌215株(64.18%),革兰阴性菌109株(32.54%),真菌11株(3.28%)。主要是凝固酶阴性葡萄球菌(115株,占34.33%)和肺炎链球菌(81株,占24.18%)。新生儿及婴儿早期的病原菌主要是凝固酶阴性葡萄球菌。耐甲氧西林凝固酶阴性葡萄球菌发生率达55.65%。葡萄球菌对青霉素、红霉素、克林霉素耐药率超过70%,对万古霉素和利奈唑烷敏感;肺炎链球菌对青霉素耐药率为8.64%,对红霉素和克林霉素耐药率较高(>60%);革兰阴性杆菌对亚胺培南、头孢哌酮/舒巴坦及阿米卡星敏感率较高,但大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶发生率为22.86%和27.59%。结论儿童细菌性脑膜炎主要病原菌是凝固酶阴性葡萄球菌和肺炎链球菌,早期准确的病原学诊断和及时采用敏感的抗菌药物治疗是降低后遗症发生率和病死率的重...     

基因检测pbp2b ply和lytA诊断儿童肺炎链球菌脑膜炎应用价值研究

目的比较青霉素结合蛋白2b(pbp2b)与自溶素(ply)、溶血素(lyt A)基因和脑脊液细菌培养在诊断国内儿童化脓性脑膜炎中肺炎链球菌感染及青霉素耐药性方面的情况,并了解肺炎链球菌青霉素结合蛋白基因型特征。方法 2006年1月至2009年9月在北京儿童医院感染内科临床严格诊断为细菌性脑膜炎患儿161例,用pbp2b及其他2个肺炎链球菌种特异的基因(ply、lyt A)巢式PCR法来检测细菌性脑膜炎患儿脑脊液中的肺炎链球菌,对不同方法结果进行比较。对其中pbp2b阳性的标本进行青霉素敏感性PCR(分别用耐药、敏感的引物进行PCR检测)、测序,并与青霉素耐药表型进行比较和评估。结果 161例中不同方法确诊的肺炎链球菌共有25例,3种基因检测均阳性的共有11例。pbp2b检测阳性16例,lyt A检测阳性16例,ply检测阳性14例。脑脊液培养阳性9例。pbp2b阳性的16例标本中,青霉素敏感和青霉素耐药基因型各占一半。16例中4例有培养结果,其中3例基因型和耐药型相符合。敏感性测定PCR和测序结果相一致。测序结果与NCBI基因库(http://blast.ncbi.nlm.nih.gov/Blast.cgi)相比,有2例为新的氨基酸序列型,但是无新的氨基酸点突变发生。由培养结果检测的肺炎链球菌脑膜炎的青霉素耐药率为66.67%(6/9),敏感性PCR检测的肺炎链球菌脑膜炎的青霉素耐药率为50%(8/16),包括脑脊液培养阴性的病例。结论 3种基因检测的敏感度均高于传统的脑脊液培养,其中pbp2b可以作为一个推荐的基因位点筛查肺炎链球菌感染,并在一定程度上预测青霉素耐药性情况。     

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目的分析儿童侵袭性肺炎链球菌疾病(IPD)的临床特征及侵袭性肺炎链球菌耐药特点。方法回顾性分析2004年1月至2011年3月苏州大学附属儿童医院收治的38例IPD患儿的临床资料及侵袭性肺炎链球菌的药敏结果。结果 (1)38例患儿中男25例,女13例,男女比为1.92∶1;年龄78d至12岁,其中<2岁18例(47.37%),2～5岁12例(31.58%),>5岁8例(21.05%)。脓毒血症25例,占65.79%,是最多见的临床疾病,其中合并肺炎10例;其次为化脓性脑膜炎12例,占31.58%,合并肺炎3例;坏死性肺炎2例,占5.26%;2例患儿同时存在脓毒血症、化脓性脑膜炎和肺炎。6例(15.79%)患儿存在基础疾病;6例(15.79%)合并其他病原感染。临床治愈33例(73%),死亡2例,自动放弃2例。(2)38株侵袭性肺炎链球菌中,青霉素不敏感率为52.63%,对其他9种常用抗生素的耐药率从高到低依次为:红霉素(94.74%)、克林霉素(93.75%)、四环素(82.25%)、复方新诺明(61.54%)、头孢噻肟(23.53%)、氯霉素(15.79%),未发现对万古霉素、左氧氟沙星、利福平耐药。多重耐药率84.21%。结论 IPD好发于5岁以内儿童尤其是2岁以内的婴幼儿,临床上主要表现为脓毒血症、化脓性脑膜炎等,加强侵袭性肺炎链球菌的耐药监测对指导临床用药有重要意义。     

儿童肺炎链球菌所致化脓性脑膜炎12例临床分析

目的 探讨肺炎链球菌所致的小儿化脓性脑膜炎的临床特点.方法 对我院2007年1月至2011年10月收治的12例肺炎链球菌所致的化脓性脑膜炎患儿的临床资料进行回顾性分析.结果 12例均为青霉素耐药肺炎链球菌,年龄2个月～9岁9个月,其中5岁以下占75％ (9/12),2岁以下41.6％(5/12),临床表现均有发热,并伴有神经系统受累症状.12例患儿均有合并症,9例合并脓毒症(75％),8例合并肺炎(66.7％),其中5例同时合并脓毒症及肺炎.实验室检查外周血白细胞计数、C反应蛋白、降钙素原、红细胞沉降率及脑脊液白细胞计数、蛋白多明显增高,脑脊液糖下降明显.12例患儿中有11例患儿最终均使用万古霉素联合三、四代头孢或其他抗生素治疗,8例治愈,2例留有严重后遗症,2例死亡.结论 应重视肺炎链球菌所致的脑膜炎,对临床怀疑肺炎链球菌所致的化脓性脑膜炎,要尽早给予包括万古霉素在内的抗生素联合治疗.     

Invasive Haemophilus influenzae type B diseases in Bangladesh, with increased resistance to antibiotics

OBJECTIVE: To determine the prevalence, age-group distribution, serotype, and antibiotic susceptibility patterns of invasive Haemophilus influenzae type b (Hib) isolates in Bangladeshi children because data regarding Hib diseases in developing countries are scarce, which has led to delay of the introduction of Hib vaccine in these countries. METHODS: Children diagnosed with meningitis (n = 1412) and pneumonia (n = 2434) were enrolled in this surveillance study for Hib invasive diseases. Cerebrospinal fluid (CSF) and blood specimens, and the subsequent isolates, were processed using standard procedures. RESULTS: During 1993 to 2003, 455 H influenzae strains were isolated from patients with meningitis (n = 425) and pneumonia (n = 30), and an additional 68 Hib meningitis cases were detected by latex agglutination (LA) testing. Overall, 35% of pyogenic meningitis cases were a result of H influenzae, 97.1% of which were Hib. Most (91.4%) cases occurred during the first year of life. Resistance to ampicillin, chloramphenicol, and cotrimoxazole was 32.5%, 21.5%, and 49.2%, respectively. There was a trend toward increasing resistance for all three drugs. Resistance to ampicillin and chloramphenicol was almost universally coexistent and was associated with increased sequelae compared with the patients infected with susceptible strains (31% [23/75] vs 11% [21/183]; P <.001). CONCLUSION: Hib is the most predominant cause of meningitis in young Bangladeshi children. Resistance to ampicillin and chloramphenicol and the high cost of third-generation cephalosporin highlight the importance of disease prevention through vaccination against Hib.     

Haemophilus influenzae meningitis in Sweden 1981-1983.

Four hundred and seventy cases of meningitis caused by Haemophilus influenza in children and 30 cases in adults were identified in Sweden between 1981 and 1983. The age specific incidence in the most susceptible age group (0-4 years) was 31/100,000/year (440 cases), which is higher than previously reported from Europe. A further 30 cases were seen in children aged 5-14. The risk of developing H influenzae meningitis before the age of 15 was 1 in 669. There were 11 deaths (2%) and five cases of serious neurological sequelae among the children. Only 18 children (4%) had predisposing diseases. All but one of the 294 strains of H influenzae from children that had been serotyped were type b. Infections in adults differed from infections in children. Five of the adults died (17%), 12 had important predisposing diseases, and at least six of the infections were caused by non-typable strains. It is concluded that research into the prevention of invasive H influenzae infections in children should have high priority.     

Epidemiology of invasive Haemophilus influenzae type b infections in Geneva, Switzerland, 1976 to 1989

We report a retrospective study of invasive Haemophilus influenzae type b (Hib) diseases in Geneva from 1976 to 1989. Among the 183 children who fulfilled the case definition, 6 (3.3%) presented with more than one site of infection. The overall incidence rate among children younger than 5 years of age was 60.2/100,000 but it was 92.1/100,000 in 1989. Forty-one percent of patients had meningitis, 37% had epiglottis and 22% had other forms of Hib infections. Fifty-four percent of cases occurred in children younger than 2 years of age. Invasive Hib infections were found more often in boys than in girls (1.6/1). From 1984, 21% of all Hib were beta-lactamase-producing strains. During the study period 2 children (1.1%) died from epiglottitis and 12 children with meningitis (15.8%) developed serious neurologic deficits. These data suggest that administration of a conjugate vaccine against Hib to all infants living in Geneva is justified.     

儿童侵袭性肺炎链球菌病的临床特征及耐药性分析

目的 总结儿童侵袭性肺炎链球菌病(IPD)的临床特征及耐药性资料,以提高对该病的诊疗水平.方法 回顾性分析2004年1月-2009年6月55例IPD患儿的临床资料;采集患儿的血液、脑脊液、腹水、纵隔及软组织引流液标本,经实验室培养、分离、鉴定出64株肺炎链球菌(SP),检测其对青霉素等抗生素的敏感性.结果 55例IPD患儿中男32例,女23例,男女比例为1.39:1.年龄47 d～12岁,其中2岁以下占62%.临床诊断败血症38例(69%);化脓性脑膜炎9例(16%);臀部或颈部脓肿7例(13%);化脓性腹膜炎1例.13例(24%)有基础疾病,以白血病最多见(31%).3例(5%)有外科手术史;3例(5%)合并病毒感染,2例(4%)合并支原体感染.发病以冬春季为主(73%),89%系社区获得性感染.临床治愈40例,好转12例,死亡3例(5%);9例(16%)出现神经系统并发症.各年度侵袭性SP检出率间差异有统计学意义(χ~2=33.93,P<0.01);青霉素中介SP和青霉素耐药SP检出率分别为30%和41%;SP对红霉素和氯林可霉素的耐药率高达94%和88%;多重耐药率达89%.结论 IPD好发于5岁以下尤其是2岁以下儿童,24%患儿存在基础疾病.临床疾病以败血症和化脓性脑膜炎最常见.     

Acute bacterial meningitis at the 'Complexe Pédiatrique' of Bangui, Central African Republic

To precis the aetiologies of children meningitis and the susceptibility to antibiotics of bacteria responsible for meningitis in Bangui, we conducted a prospective study between October 2004 and September 2005, at the 'Complexe Pédiatrique de Bangui', Central African Republic (CAR). Children from 1 day to 16 years with suspected meningitis and who underwent a lumbar puncture were enrolled. Gram staining, culture on chocolate blood medium, cell count, biochemistry (protein level, glucose ratio), capsular antigen detection were performed for each cerebrospinal fluid. MICs were determined by the E-test method. Four hundred and seventeen patients were enrolled during the study period; 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. Among proven bacterial meningitis, Streptococcus pneumoniae was the most common organism responsible for meningitis (62 cases, 48%) followed by Haemophilus influenzae (46 cases, 35%) and by Neisseria meningitidis and Salmonella sp. (8 cases, 6% each). Ninety-four percent and 96% of S. pneumoniae strains tested remain susceptible to benzylpenicilline and chloramphenicol, respectively. A beta-lactamase was detected in 92% of H. influenzae strains tested. However, MICs 50% and 90% for amoxicillin were found to be 1 and 4 mg/l, respectively and 33% of these strains were resistant to chloramphenicol. The global mortality rate was 35% (59/167). This mortality rate was 47% for S. pneumoniae, 33% for H. influenzae, 62% for Salmonella sp. and 13% for N. meningitidis. The probabilistic treatment with ampicillin and chloramphenicol usually administered for children meningitis in Bangui must be reconsidered particularly in cases of H. influenzae meningitis. It is of importance to reduce the presentation delays of children with suspected meningitis in Bangui. The H. influenzae b immunization would allow a dramatic reduction of meningitis cases and deaths in Central African children.     

Epidemiology of meningitis and bacteraemia due to Streptococcus pneumoniae in The Netherlands

In The Netherlands, accurate data on the epidemiology of pneumococcal meningitis are available through a clinical microbiology laboratory-based national surveillance of cerebrospinal fluid isolates. The Netherlands Reference Laboratory for Bacterial Meningitis receives isolates of about 80% of all meningitis cases and about 40% of bacteraemic cases. The incidence of pneumococcal meningitis has increased slowly from 1.0/100000 in 1990 to 1.5/100000 since 1996. The highest age-specific incidence of meningitis was observed in children <5y of age (8.2/100000 in 1999). Of all isolates, 35% were from children <5 y of age. The number of isolates from non-meningitis patients with bacteraemia increased considerably since the early 1990s, especially among the elderly. The highest incidence was found in 1996, probably owing to a relatively severe winter. During 1995–1999, pneumococcal meningitis in The Netherlands was caused mainly by serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Of the cases in children <15y, almost half were caused by serotypes 6B, 14, 18C, and 19F. The serotypes present in the 23-valent polysaccharide and 7-valent conjugate vaccines accounted for 87% and 47% of all meningitis cases, respectively. Pneumococcal resistance to penicillin in The Netherlands is still low, at about 1%. Genotypically, resistant strains belong to many clones. Horizontal transfer of capsular genes occurs among these isolates. In The Netherlands, 45% of cases of pneumococcal meningitis have severe predisposing factors. The case-fatality rate was significantly higher among patients with impaired immunity than among those with a break in the integrity of the dura.     

Epidemiology of meningitis and bacteraemia due to Streptococcus pneumoniae in The Netherlands

In The Netherlands, accurate data on the epidemiology of pneumococcal meningitis are available through a clinical microbiology laboratory-based national surveillance of cerebrospinal fluid isolates. The Netherlands Reference Laboratory for Bacterial Meningitis receives isolates of about 80% of all meningitis cases and about 40% of bacteraemic cases. The incidence of pneumococcal meningitis has increased slowly from 1.0/100,000 in 1990 to 1.5/100,000 since 1996. The highest age-specific incidence of meningitis was observed in children < 5 y of age (8.2/100,000 in 1999). Of all isolates, 35% were from children < 5 y of age. The number of isolates from non-meningitis patients with bacteraemia increased considerably since the early 1990s, especially among the elderly. The highest incidence was found in 1996, probably owing to a relatively severe winter. During 1995-1999, pneumococcal meningitis in The Netherlands was caused mainly by serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Of the cases in children < 15 y, almost half were caused by serotypes 6B, 14, 18C, and 19F. The serotypes present in the 23-valent polysaccharide and 7-valent conjugate vaccines accounted for 87% and 47% of all meningitis cases, respectively. Pneumococcal resistance to penicillin in The Netherlands is still low, at about 1%. Genotypically, resistant strains belong to many clones. Horizontal transfer of capsular genes occurs among these isolates. In The Netherlands, 45% of cases of pneumococcal meningitis have severe predisposing factors. The case-fatality rate was significantly higher among patients with impaired immunity than among those with a break in the integrity of the dura.     

小儿再发性化脓性脑膜炎28例分析

目的探讨小儿再发性化脓性脑膜炎(以下简称再发化脑)可能的病因及相应治疗对策。方法回顾分析1995—2004年在天津市儿童医院神经科住院的28例再发化脑患儿的临床资料,以及根据可能病因分别行头MR、脊髓MR、颞骨CT、脑干电测听、血IG和血培养等检查。结果28例再发化脑的病因:脑脊液鼻漏13例、脑脊液耳漏8例、脑脊液耳鼻漏1例、潜毛窦5例、体液免疫缺陷病1例。给予急性期抗感染治疗,恢复期根据病情分别给予脑脊液鼻漏修补术,脑脊液耳漏、脑脊液耳鼻漏、内耳修补术,潜毛窦切除术,随诊6个月至2年未再复发。结论化脑是中枢神经系统严重感染性疾病,重者可危及生命。首发化脑就应注意寻找病因,再发化脑更应积极寻找病因并祛除病因,防止再发。     

Nontypeable Haemophilus influenzae meningitis in children: phenotypic and genotypic characterization of isolates

BACKGROUND: With the decline in the incidence of invasive Haemophilus influenzae type b disease as result of routine immunization of infants, the potential emergence of nontypeable H. influenzae (NTHi) strains as important pathogens has been suggested. METHODS: From June 1997 to July 2006, 9 cases of NTHi meningitis in children aged < or =60 months were detected. The 9 NTHi isolates were characterized. Antimicrobial susceptibility patterns were determined by E-test. The transpeptidase domain of penicillin binding protein 3 of a beta-lactamase negative ampicillin-resistant strain was sequenced. Genetic relatedness among isolates was assessed by pulsed field gel electrophoresis and by multilocus sequence typing. The presence of HMW and Hia adhesins and hemagglutinating fimbriae was investigated by PCR and Western Blotting. RESULTS: The 9 cases of NTHi meningitis did not occur in specific risk groups, except for one patient. Of the 9 NTHi isolates, 2 were beta-lactamase producers and 1 showed the beta-lactamase negative ampicillin-resistant phenotype. Sequencing of the penicillin binding protein 3 revealed novel amino acid substitutions. A high degree of genetic diversity among isolates was demonstrated by pulsed field gel electrophoresis. Multilocus sequence genotyping confirmed that the 9 NTHi isolates did not belong to related phylogenetic clusters. HMW adhesins were found in 2 isolates, and 5 strains possessed Hia. No hemagglutinating fimbriae were detected, even though 2 isolates contained hifA gene sequences. CONCLUSION: NTHi isolates from cases of meningitis in children are genetically diverse. Distribution of adhesins among the isolates we examined is unusual: most strains express Hia that generally occurs in a minority of strains in NTHi, suggesting that this adhesin may play a role in virulence mechanisms of NTHi causing meningitis.