大肠埃希菌致新生儿化脓性脑膜炎31例临床分析

Clinical analysis of 31 cases of neonatal purulent meningitis caused by Escherichia coli

摘要:

目的：化脓性脑膜炎是导致新生儿死亡、致残的重要病因,大肠埃希菌是最常见的致病菌，通过探讨该病的临床特点及耐药性情况，为早期诊断及合理治疗提供依据。方法：对近10年31例新生儿大肠埃希菌脑膜炎的临床资料进行回顾性分析。结果：临床以发热、少吃或拒乳、反应差、惊厥等表现多见。并发低钠血症17例、脑积水8例、硬膜下积液2例、脑室管膜炎2例、脑梗死1例。CRP升高30例，占97%。治愈14例，不良预后12例（其中死亡5例）。2007~2011年大肠埃希菌对常用的青霉素类、头孢菌素类耐药率达50%以上，明显高于2001~2006年。2007～2011年产超广谱β-内酰胺酶（ESBLs）菌株检出率为57%，而2001~2006年未检出产ESBLs菌株。结论：新生儿大肠埃希菌脑膜炎临床表现多样，预后欠佳。CRP检查有较高的早期诊断价值。大肠埃希菌对头孢菌素类抗菌药物耐药性上升最为显著，产ESBLs菌株检出率近年有明显增高趋势。

Abstract:

OBJECTIVE: Neonatal purulent meningitis is a severe infection responsible for high mortality and disabling sequelae. Escherichia coli is the main pathogen of neonatal purulent meningitis. This study explored the clinical characteristics and antibiotic resistance of Escherichia coli-induced neonatal meningitis. METHODS: A retrospective chart review was performed. A total of 31 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the neonatal intensive care unit between January 1, 2001 and December 31, 2011. The clinical characteristics and antibiotic sensitivity test results were analyzed. RESULTS: Fever, poor feeding, lethargy and seizure were common clinical signs of neonatal purulent meningitis caused by Escherichia coli. Acute complications mainly included hyponatremia (17 cases), hydrocephalus (8 cases), subdural collection (2 cases), ventriculitis (2 cases) and cerebral infarction (1 case). Thirty neonates (97％) had increased CRP levels. Of the 31 patients, 14 cases were cured and 12 had adverse outcomes (5 patients died during hospitalization). Escherichia coli strains were resistant (>50%) to commonly used penicillins and cephalosporins between 2007 and 2011, presenting significantly higher resistance rates than between 2001 and 2006. The detection rate of extended spectrum β-lactamases (ESBLs)-producing strains between 2007 and 2011 increased significantly compared with between 2001 and 2006 (57% vs 0). CONCLUSIONS: The clinical manifestations of neonatal purulent meningitis caused by Escherichia coli are non specific. The outcome is poor. Monitoring of CRP levels is valuable for the early diagnosis of neonatal purulent meningitis. The antimicrobial resistance rates of Escherichia coli are increasing, especially to cephalosporins. The percentage of ESBLs-producing strains is increasing over the years.