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.
关键词
屎肠球菌 /
脑膜炎 /
儿童
Key words
Enterococcus faecium /
Meningitis /
Child
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参考文献
[1] Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults——A review of 493 episodes[J]. New Engl J Med, 1993, 328(1):21-28.
[2] Chandrasekar PH, Brown WJ. Clinical issues of blood cultures[J]. Arch Intern Med, 1994, 154(8):841-849.
[3] Pintado V, Cabellos C, Moreno S, et al. Enterococcal meningitis:a clinical study of 39 cases and review of the literature[J]. Medicine(Baltimore), 2003, 82(5):346-364.
[4] 强光峰, 胡冰, 刘钢. 婴儿屎肠球菌脑膜炎一例[J]. 中华传染病杂志, 2016, 34(11):692-694.
[5] 李玲. 屎肠球菌致化脓性脑膜炎1例[J]. 皖南医学院学报, 2006, 25(1):44.
[6] 范宁. 腰椎间盘突出症手术合并屎肠球菌感染性脑膜炎一例报道[J]. 齐鲁医学检验, 2004, 15(6):66.
[7] 邱佳冀, 汤劼, 张力伟, 等. 利奈唑胺治愈开颅手术后耐万古霉素屎肠球菌脑室炎一例并文献复习[J]. 中华神经外科杂志, 2013, 29(12):1279-1280.
[8] van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline:diagnosis and treatment of acute bacterial meningitis[J]. Clin Microbiol Infect, 2016, 22(Suppl 3):S37-S62.
[9] Vu J, Carvalho J. Enterococcus:review of its physiology, pathogenesis, diseases and the challenges it poses for clinical microbiology[J]. Front Biol, 2011, 6(5):357-366.
[10] Inan D, Gunseren F, Colak D, et al. First confirmed case of vancomycin-resistant enterococcus faecium meningitis in Turkey[J]. J Chem, 2004, 16(6):608-611.
[11] Suara RO, Dermody TS. Enterococcal meningitis in an infant complicating congenital cutis aplasia[J]. Pediatr Infect Dis J, 2000, 19(7):668-669.
[12] Patel T, Lewis ME, Niesley ML, et al. Postneurosurgical central nervous system infection due to enterococcus faecalis successfully treated with intraventricular vancomycin[J]. Infect Dis Clin Pract (Baltim Md), 2016, 24(3):174-176.
[13] Emaneini M, Hosseinkhani F, Jabalameli F, et al. Prevalence of vancomycin-resistant enterococcus in Iran:a systematic review and meta-analysis[J]. Eur J Clin Microbiol Infect Dis, 2016, 35(9):1387-1392.
[14] Edelsberg J, Weycker D, Barron R, et al. Prevalence of antibiotic resistance in US hospitals[J]. Diagn Microbiol Infect Dis, 2014, 78(3):255-262.
[15] 胡付品, 朱德妹, 汪复, 等. 2013年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志, 2014, 14(5):365-374.
[16] 胡付品,朱德妹,汪复,等. 2015年CHINET细菌耐药性监测[J]. 中国感染与化疗杂志, 2016, 16(6):685-694.
[17] 胡付品,郭燕,朱德妹, 等. 2016年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志, 2017, 17(5):481-491.
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