88例细菌性脑膜炎患者的临床及病原学分析
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摘要
目的分析复旦大学附属华山医院重症监护室(ICU)2013-2017年收治的急性细菌性脑膜炎患者的临床特征和病原构成,为拟订经验治疗方案提供依据。方法查阅本院ICU 2013-2017年收治的细菌性脑膜炎88例患者的临床资料并进行回顾性分析。结果入选病例中,77例(87.5%)发热; 67例(76.1%)诉头痛; 21例(23.9%)表现脑膜刺激征。脑脊液白细胞数在100×10~6/L以上46例(52.3%);脑脊液葡萄糖含量在正常值下限(2.5mmol/L)以下的43例(48.9%)。脑脊液培养共培养出细菌27株,其中主要为凝固酶阴性葡萄球菌(10株)和鲍曼不动杆菌(7株)。结论本院ICU收治的急性细菌性脑膜炎患者最常见的临床症状为发热和头痛。分离到的病原菌以凝固酶阴性葡萄球菌为主。
Objective To understand the pathogens and clinical symptoms of bacterial meningitis by analyzing the relevant data of 88 patients in ICU, Huashan Hospital during the period from 2013 to 2017, for the purpose to improve patient outcomes.Methods The clinical and microbiological data of 88 patients with bacterial meningitis in ICU, Huashan Hospital during the period from 2013 to 2017 were retrospectively reviewed and analyzed. Results Among the 88 cases, 77(87.5%) had fever, 67(76.1%) had headache, 21(23.9%) had meningeal irritation signs. The leukocyte count in cerebrospinal fluid weas higher than 100×10~6/L in 46(52.3%) cases. The glucose level in cerebrospinal fluid was lower than the lower limit of normal(2.5 mmol/L) in 43(48.9%) cases.A total of 27 bacterial strains were isolated, including 10 strains of coagulase-negative Staphylococcus and 7 strains of Acinetobacter baumannii. Conclusions Fever and headache are the most common clinical symptoms of bacterial meningitis in this report.Coagulase-negative Staphylococcus is the most frequently isolated bacterial pathogen.
Objective To understand the pathogens and clinical symptoms of bacterial meningitis by analyzing the relevant data of 88 patients in ICU, Huashan Hospital during the period from 2013 to 2017, for the purpose to improve patient outcomes.Methods The clinical and microbiological data of 88 patients with bacterial meningitis in ICU, Huashan Hospital during the period from 2013 to 2017 were retrospectively reviewed and analyzed. Results Among the 88 cases, 77(87.5%) had fever, 67(76.1%) had headache, 21(23.9%) had meningeal irritation signs. The leukocyte count in cerebrospinal fluid weas higher than 100×10~6/L in 46(52.3%) cases. The glucose level in cerebrospinal fluid was lower than the lower limit of normal(2.5 mmol/L) in 43(48.9%) cases.A total of 27 bacterial strains were isolated, including 10 strains of coagulase-negative Staphylococcus and 7 strains of Acinetobacter baumannii. Conclusions Fever and headache are the most common clinical symptoms of bacterial meningitis in this report.Coagulase-negative Staphylococcus is the most frequently isolated bacterial pathogen.
引文
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[3]胡瑛霞,韩杰.301例中枢神经系统感染的临床分析[J].医学与哲学(B),2014,35(5):52-54.
[4]THIGPEN M C,WHITNEY C G,MESSONNIER N E,et al.Bacterial meningitis in the United States,1998-2007[J].N Engl J Med,2011,364(21):2016-2025.
[5]中华医学会神经外科学分会.中国神经外科重症患者感染诊治专家共识(2017)[J].中华医学杂志,2017,97(21):1607-1614.
[6]答嵘,王伟,刘军辉,等.脑脊液生化指标在中枢神经系统感染诊断中的价值[J].国际检验医学杂志,2015,36(18):2635-2637.
[7]RAMOS-MARTíNEZ A,DE LAS HERAS-CARBALLO T,FERNáNDEZ-MATEOS C,et al.Postsurgical meningitis differential characteristics of aseptic postsurgical meningitis[J].Neurocirugía,2009,20(2):103-109.
[8]朱任媛,张小江,徐英春,等.2005-2014年CHINET脑脊液分离菌分布和耐药性监测[J].中国感染与化疗杂志,2016,16(4):449-454.