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.
关键词
肺炎链球菌 /
脑膜炎 /
临床特点 /
耐药 /
儿童
Key words
Streptococcus pneumoniae /
Meningitis /
Clinical characteristics /
Drug resistance /
Child
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参考文献
[1] WHO. Pneumococoal conjugate vaccine for childhood immunization—WHO position paper[J]. Wkly Epidemiol Rec, 2007, 82(12): 93-104.
[2] Mathers CD, Lopez AD, Murray CJL. The burden of disease and mortality by condition: Data, methods and results for 2001[M]// Lopez AD, Mathers CD, Ezzati M, et al. Global burden of disease and risk factors. United States: Oxford University Press, 2006: 45-270.
[3] Molyneux E, Riordan FA, Walsh A. Acute bacterial meningitis in children presenting to the Royal Liverpool Children's Hospital, Liverpool, UK and the Queen Elizabeth Central Hospital in the Blantyre, Malawi: a world of difference[J]. Ann Trop Paediatr, 2006, 26(1): 29-37.
[4] 胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第7 版. 北京: 人民卫生出版社, 2002: 921-922.
[5] Lynch JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines[J]. Curr Opin Pulm Med, 2010, 16(3): 217-225.
[6] Brautest LV, Heiby EA, Syvenrsen G, et al. Invasive pneumoccal disease in children in Oslo 1998-2004[J]. Tidsskr Nor Laegeforen, 2008, 128 (12): 1380-1383.
[7] 苏小燕, 温顺航, 林立, 等. 儿童肺炎链球菌败血症的临床特点及药敏分析[J]. 中国当代儿科杂志, 2013, 15(11): 995-999.
[8] Dagan R. Use of pneumococcal conjugate vaccine to decrease rates of bacterial meningitis[J]. Clin Infect Dis, 2008, 46(11): 1673-1676.
[9] Abdinia B, Ahangarzadeh Rezaee M, Abdoli Oskouie S. Etiology and antimicrobial resistance patterns of acute bacterial meningitis in children: a 10-year referral hospital-based study in northwest iran[J]. Iran Red Crescent Med J, 2014, 16(7): e17616.
[10] 廉荣镇, 肖能. 脑膜炎患儿脑脊液中肺炎链球菌的耐药性初步分析[J]. 当代医学, 2011, 17(3): 138-139.
[11] 刘素云, 董琳, 杨锦红. 儿童侵袭性肺炎链球菌病的临床特征及耐药性分析[J]. 中华儿科杂志, 2010, 48(2): 95-99.
[12] 王曼丽, 严永东, 黄莉, 等. 侵袭性肺炎链球菌感染38 例临床特征与药敏分析[J]. 中国实用儿科杂志, 2012, 27(8): 604-607.
[13] 徐丽慧, 王贤军, 方美玉, 等. 肺炎链球菌大环内酯药物耐药 性及耐药基因erm、mef 的检测[J]. 中华传染病杂志, 2010, 28(3): 174-177.
[14] 熊小雨, 刘春峰, 孙继梅, 等. 5 岁以下儿童侵袭性肺炎链球菌病的临床特点与耐药性分析[J]. 中国小儿急救医学, 2012, 19(6): 599-602.
[15] Tsai HY, Lauderdale TL, Wang JT, et al. Updated antibiotic resistance and clinical spectrum of infections caused by Streptococcus pneumoniae in Taiwan: emphasis on risk factors for penicillin nonsusceptibilities[J]. J Microbiol ImmunolInfect, 2013, 46(5): 345-351.
[16] Kim SH, Song JH, Chung DR, et al. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumonia isolates in Asian countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) study[J]. Antimicrob Agents Chemother, 2012, 56(3): 1418-1426.
[17] Van Bambeke F1, Reinert RR, Appelbaum PC, et al. Multidrugresistant Streptococcus pneumoniae infections: current and future therapeutic options[J]. Drugs, 2007, 67(16): 2355-2382.
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