儿童肺炎链球菌脑膜炎的临床特点及耐药性分析

Clinical characteristics of children with meningitis caused by Streptococcus pneumoniae and antibiotic resistance of Streptococcus pneumoniae strains

摘要:

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/dL。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。

Abstract:

Objective To study the clinical characteristics of children with meningitis caused by Streptococcus pneumoniae (SP) and the drug sensitivity of SP strains. Methods A retrospective analysis was performed on the clinical data of 14 children with SP-infected meningitis between September 2008 and March 2014. Results Of the 14 cases, 8 cases (57%) aged under 2 years. 13 cases (93%) had fever, 9 cases (64%) had convulsions, and 7 cases (50%) were complicated by septicemia. Eleven cases (79%) had elevated white blood cell (WBC) counts and 10 cases (71%) had elevated serum C-reactive protein (CRP) levels. All 14 children had an elevated nucleated cell count and neutrophils were identified as the predominant cell type. CSF protein >1 000 mg/dL was noted in 9 cases (64%). Ten cases (71%) were cured, 2 cases (14.2%) with sequelae and 2 cases (14.2%) died. The drug sensitivity analysis showed that SP had resistance rates of more than 60% to penicillin, erythromycin, clindamycin, tetracycline and sulfa, but it was sensitive to amoxicillin (93%), vancomycin (100%), chloramphenicol (100%) and levofloxacin (100%). Conclusions The clinical characteristics of children with meningitis caused by SP are not different from those with meningitis caused by other bacteria. SP strains are resistant to common antibiotics used in clinical practice, so it is important to monitor the drug resistance of the strains.