2014—2018年天津市儿童医院化脓性脑膜炎病原菌分布及耐药性分析

目的 分析2014—2018年天津市儿童医院化脓性脑膜炎病原菌的分布和耐药性，为临床合理应用抗菌药物提供依据。方法 收集2014年1月—2018年12月在天津市儿童医院住院，经脑脊液或血液培养细菌阳性的化脓性脑膜炎患儿121例，统计并分析化脓性脑膜炎病原菌的分布和耐药性。结果 化脓性脑膜炎患儿的年龄分布主要为<28 d和28 d～1岁，构成比分别为26.5%、41.3%。共分离出121株病原菌，其中革兰阳性菌85株，占70.2%，主要为肺炎链球菌、表皮葡萄球菌和无乳链球菌；革兰阴性菌36株，占29.8%，主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌。不同年龄段化脓性脑膜炎患儿感染的病原菌不同。肺炎链球菌、表皮葡萄球菌和无乳链球菌均对利奈唑胺和万古霉素完全敏感。肺炎链球菌对左氧氟沙星和莫西沙星也完全敏感，对克林霉素和红霉素的耐药率均高达95.6%；表皮葡萄球菌对苄青霉素、苯唑西林和红霉素的耐药率较高；无乳链球菌对克林霉素和红霉素耐药率较高，对其他抗菌药物均完全敏感。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌均对阿米卡星完全敏感。大肠埃希菌对呋喃妥因也完全敏感，对氨苄西林、哌拉西林的耐药率高达80%；肺炎克雷伯菌对妥布霉素和环丙沙星也完全敏感，对氨苄西林的耐药率高达80.0%；铜绿假单胞菌对头孢他啶、庆大霉素和妥布霉素也完全敏感，对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛、头孢替坦、头孢曲松、复方新诺明和呋喃妥因的耐药率均高达100.0%，对其他抗菌药物的耐药率均为25.0%。结论 不同年龄段化脓性脑膜炎患儿感染病原菌不同，临床经验用药时应根据患儿发病年龄和耐药性情况选择不同的抗菌药物，提高治疗的针对性。

Distribution and drug resistance of pathogenic bacteria from children with purulent meningitis in Tianjin Children's Hospital from 2014 to 2018

Objective To investigate the distribution and drug resistance of pathogenic bacteria from children with purulent meningitis in Tianjin Children''s Hospital from 2014 to 2018, and to provide the reference for reasonable use of antibiotics. Methods Children (121 cases) with purulent meningitis with positive bacterial culture by cerebrospinal fluid or blood in Tianjin Children''s Hospital from 2014 to 2018 were selected, and the distribution and drug resistance of pathogenic bacteria were analyzed statistically. Results The main age of children with purulent meningitis were <28 d and 28 d-1 years old with the rate of 26.5% and 41.3%. A total of 121 samples were collected, in which Gram-positive bacteria (85 strains) accounted for 70.2%, and main of them were Streptococcus pneumoniae, Staphylococcus epidermidis, and Streptococcus agalactiae. Gram-negative bacteria were 36 strains (29.8%), and main of them were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The pathogenic bacteria of purulent meningitis in children of different ages are different. S. pneumoniae, S. epidermidis, and S. agalactiae were completely sensitive to linezolid and vancomycin. S. pneumoniae was completely sensitive to levofloxacin and moxifloxacin, and the drug resistance rate against clindamycin and erythromycin were 95.6%. S. epidermidis was resistant to benzylpenicillin, oxacillin, and erythromycin. The drug resistance rate of S. agalactiae against clindamycin and erythromycin was high, and were completely sensitive to other antibiotics. E. coli, K. pneumoniae, and P. aeruginosa were completely sensitive to amikacin. E. coli was also completely sensitive to macrodantin, and the drug resistance rate against ampicillin and piperacillin were 80.0%. K. pneumoniae was also completely sensitive to tobramycin and ciprofloxacin, and the drug resistance rate against ampicillin were 80.0%. P. aeruginosa was also completely sensitive to ceftazidime, gentamicin, and tobramycin, and the drug resistance rate against ampicillin, ampicillin/sulbactam, cefazolin, cefuroxime, cefotetan, ceftriaxone, sulfamethoxazole, and macrodantin were 100.0%, and the drug resistance rate against other antibiotics were 25.0%. Conclusion The pathogenic bacteria of purulent meningitis in children of different ages are different. According to clinical experience, different antimicrobial agents should be selected according to the age of onset and the situation of drug resistance to improve the pertinence of treatment.