儿童屎肠球菌脑膜炎的临床特征分析

Clinical features of Enterococcus faecium meningitis in children

摘要:

目的 总结屎肠球菌脑膜炎患儿的临床特点，以期提高临床诊治水平。方法 对9例屎肠球菌脑膜炎患儿进行临床资料分析。结果 9例患儿均经血液或脑脊液或PICC端培养出屎肠球菌，其中6例（67%）为新生儿，2例（22%）为6个月以内婴儿，1例（11%）为3岁4个月幼儿。56%的患儿起病前存在致病高危因素：肠道感染、脑积水术后安置引流管，以及颅骨骨折、导管相关性感染和母亲围产期感染。以发热、反应差为主要表现，22%的患儿出现抽搐，均无脑膜刺激征及意识障碍。血常规白细胞总数及CRP正常或升高；脑脊液有核细胞正常或轻度升高，蛋白明显升高，糖降低。药敏均提示对万古霉素敏感，且万古霉素治疗有效，1例出现脑积水并发症。结论 屎肠球菌脑膜炎主要见于新生儿及婴儿，存在致病高危因素的比例高，临床特征不典型，对万古霉素敏感。

Abstract:

Objective To summarize the clinical features of Enterococcus faecium meningitis in children. Methods The clinical data of nine children with Enterococcus faecium meningitis were analyzed. Results In all the nine children, Enterococcus faecium was isolated from blood, cerebrospinal fluid, or peripherally inserted central catheters; 6 (67%) patients were neonates, 2 (22%) patients were younger than 6 months, and 1 (11%) patient was three years and four months of age. In those patients, 56% had high-risk factors before onset, which included intestinal infection, resettlement of drainage tube after surgery for hydrocephalus, skull fracture, perinatal maternal infection history, and catheter-related infection. The main symptoms were fever and poor response. In those patients, 22% had seizures; no child had meningeal irritation sign or disturbance of consciousness. The white blood cell count and level of C-reactive protein were normal or increased; the nucleated cell count in cerebrospinal fluid was normal or mildly elevated; the protein level was substantially elevated; the glucose level was decreased. The drug sensitivity test showed that bacteria were all sensitive to vancomycin and the vancomycin treatment was effective. Only one child had the complication of hydrocephalus. Conclusions Enterococcus faecium meningitis occurs mainly in neonates and infants. The patients have atypical clinical features. A high proportion of patients with Enterococcus faecium meningitis have high-risk factors. Enterococcus faecium is sensitive to vancomycin.