儿童细菌性脑膜炎95例病原菌分布和预后分析

目的了解儿童细菌性脑膜炎(BM)病原菌分布、细菌耐药性、临床特征和预后。方法回顾分析2011年1月至2015年7月期间住院治疗的病原体明确的BM患儿的临床资料。按出院时结局将患儿分为结局良好和结局不良组。分析比较各组患儿的病原菌分布、细菌耐药性、临床特征及预后。结果共纳入95例病原体明确的BM患儿,其中69例(72.6%)为革兰阳性菌,以肺炎链球菌(43例,45.3%)占首位;26例为革兰阴性菌(27.4%),以大肠埃希菌(13例,13.7%)占首位。肺炎链球菌和大肠埃希菌对青霉素的耐药率均超过了50%。BM患儿神经系统并发症包括硬膜下积液、脑积水、脑实质损伤,以及听力和视力损伤等。多元logistic回归分析显示,意识障碍、昏迷、脑脊液葡萄糖水平低下是BM患儿出院时不良结局的独立危险因素。结论儿童BM的病原体以肺炎链球菌和大肠埃希菌为主,对青霉素的耐药率高。BM患儿可出现不同程度的神经系统后遗症,意识改变和异常以及脑脊液葡萄糖水平低下提示患儿出院时不良结局。

The distribution of pathogens and prognosis in ninety-five children with etiology confirmed bacterial meningitis

Objective To explore the distribution of pathogens, bacterial drug resistance, clinical features and prognosis of bacterial meningitis (BM) in children.MethodsThe clinical data of children diagnosed with BM during January 2011 to July 2015 were retrospectively analyzed. Children were divided into good outcome group and poor outcome group by the outcome at discharge. The distribution of pathogens, bacterial drug resistance, clinical features, and prognosis were analyzed among different groups.ResultsThere were included 95 children diagnosed with BM,. among whom 69 (72.6%) children had Gram-positive bacterial infections with predominantStreptococcus pneumonia (43 cases, 45.3%) and 26 (27.4%) children had Gram-negative bacterial infections with predominantEscherichia coli (13 cases, 13.7%). More than 50%Streptococcus pneumonia andEscherichia coli were resisted to penicillin. The neurological complications in children with BM included subdural effusions, hydrocephalus, cerebral parenchyma injury, and hearing and visual impairment, et.al. Multivariate logistic regression analysis showed that consciousness, coma, and low level of glucose in cerebrospinal lfuid were the independent risk factors for adverse outcome at discharge.ConclusionStreptococcus pneumonia andEscherichia coli were the predominant pathogens in children with BM with high resistance rate to penicillin. BM children may have varying degrees of neurological sequelae. The unconsciousness and low level of glucose in cerebrospinal lfuid were associated with unfavorable outcomes at discharge.