116例细菌性脑膜炎儿童脑脊液病原菌分布及耐药性分析

目的：了解小儿细菌性脑膜炎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依据。方法：回顾分析2008年1月至2012年6月昆明市儿童医院5097例小儿脑脊液中的病原菌分离培养结果及其药敏试验情况。采用K-B纸片法对病原菌进行常用抗生素的敏感性检测并进行分析。结果：5年来共从5097例脑脊液标本中检出病原菌116株,其中革兰阳性菌77株（66.4％），革兰阴性菌30株（25.9％），真菌9株（7.8％），阳性率为2.28%（116/5097）。排名前6 位的病原菌依次为表皮葡萄球菌32株(27.6%)，肺炎链球菌15株(12.9%),大肠埃希菌15株(12.9%)，溶血葡萄球菌9株(7.8%)，新型隐球菌8株(6.9%)，金黄色葡萄球菌6株(5.2%)。新生儿及婴儿早期的病原菌主要是凝固酶阴性葡萄球菌，其对青霉素、红霉素、克林霉素敏感率均低于40%；肺炎链球菌对青霉素敏感率仅为13.4%，而对红霉素和克林霉素敏感率达到60.0%；但未见万古霉素耐药的葡萄球菌和肺炎链球菌。革兰阴性杆菌对亚胺培南、美洛培南、头孢哌酮/舒巴坦及头孢吡肟敏感率较高。结论：近5年来小儿细菌性脑膜炎患者病原菌以革兰阳性球菌为主,检出病原菌对常用抗生素耐药性较高；另外，新型隐球菌检出占有一定的比例，应高度注意新型隐球菌性脑膜炎，防止误诊和漏诊。

Frequency distribution and antibiotic resistance of pathogens from the cerebrospinal fluid of 116 children with bacterial meningitis

Objective To determine the frequency distribution and antibiotic resistance of pathogens isolated from the cerebrospinal fluid samples of children with bacterial meningitis(BM) and to provide a basis for the timely and effective treatment of childhood BM.Methods Retrospective analysis was performed on pathogens isolated from 5097 cerebrospinal fluid samples collected from children in Kunming Children′s Hospital between January 2008 and June 2012,as well as drug sensitivity test results.Kirby-Bauer antibiotic testing was used to analyze the sensitivity of these pathogens to commonly used antibiotics.Results A total of 116 pathogen strains were detected from the 5097 cerebrospinal fluid samples,including 77(66.4%) Gram-positive strains,30(25.9%) Gram-negative strains,and 9(7.8%) fungal strains,with a positive rate of 2.28%.The six most frequently isolated pathogens were Staphylococcus epidermidis(32 strains,27.6%),Streptococcus pneumoniae(15 strains,12.9%),Escherichia coli(15 strains,12.9%),Staphylococcus haemolyticus(9 strains,7.8%),Cryptococcus neoformans(8 strains,6.9%) and Staphylococcus aureus(6 strains,5.2%).Coagulase-negative staphylococci was the predominant pathogen in neonates and young infants with BM,and its sensitivity rates to penicillin,erythromycin and clindamycin were lower than 40%.Streptococcus pneumoniae had a penicillin sensitivity rate of 13.4%,while sensitivity rates to erythromycin and clindamycin reached 60.0%.No Staphylococcus and Streptococcus pneumoniae pathogens resistant to vancomycin were found.Gram-negative bacilli had relatively high sensitivity rates to imipenem,meropenem,cefoperazone/sulbactam and cefepime.Conclusions Gram-positive cocci are the predominant pathogens for childhood BM over the past five years.The detected pathogens develop high resistance to commonly used antibiotics.To prevent misdiagnosis,careful attention should be paid to BM caused by Cryptococcus neoformans.