Johnson W B, Adedoyin O T, Abdulkarim A A, Olanrewaju W I
Department of Paediatrics/Child Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Afr J Med Med Sci. 2001 Dec;30(4):295-303.
Empirical antimicrobial therapy remainsjustifiable in childhood pyogenic meningitis (CPM), but the continuing efficacy in a particular setting requires periodic microbiological surveillance. It was this need that informed the present five-year retrospective study of consecutive admissions for CPM at the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Of the 71 cerebro-spinal fluid [CSF] analyses, 41 (57.6%) were Gram-smear positive (GSP). Gram-positive cocci (GPC) were identified in 23 (56.1%) smears, while 14 (34.2.%) had Gram-negative bacilli (GNB). Only three (7.3%) had Gram-negative diplococci (GND). Despite corroborative biochemical findings, the remaining 30 (42.3%), including two with tuberculous meningitis proved smear-negative. GPC cases had a mean age of 4.49 +/- 5.3yrs, GNB, 3.06 +/- 4.8yrs and GND, 4.47 +/- 4.9yrs. CSF isolates were made in 28 (39.4%) cases. Streptococcus pneumoniae accounted for a predominant 22 (78.6%) (P = 0.00), Haemophilus influenzae for 2 (7.1%), and Neisseria meningitidis for only 1 (3.5%) case. Whereas Strept. pneumoniae and H. influenzae isolates were uniformly sensitive to each of sultamicillin, cefuroxime, ceftriaxone and ceftazidime, 7.7% of Strept. pneumoniae were resistant to crystalline penicillin, 6.7% to ampicillin, and 69.2% to chloramphenicol; one of the two H. influenzae isolates was chloramphenicol-resistant. Amongst the 30 (42.3%) fatal cases, the length of stay was significantly shorter in GNB-positive cases (P = 0.045). Mortality was significantly higher amongst cases with purulent/turbid CSF at admission (P = 0.03), and in those with CSF protein of >150mg/dl (P = 0.02) and glucose <1mg/dl (P = 0.047). The present aetiological preponderance of GPC and Strept. pneumoniae in our study population, the high case-fatality, and the emerging resistance profile suggest the need for exploring additional control options including vaccination. We emphasize the need for periodic auditing of local antimicrobial policies in CPM.
经验性抗菌治疗在儿童化脓性脑膜炎（CPM）中仍然是合理的，但在特定情况下持续的疗效需要定期进行微生物学监测。正是这种需求促使了在尼日利亚伊洛林大学教学医院急诊儿科病房（EPU）对CPM连续入院病例进行的为期五年的回顾性研究。在71份脑脊液[CSF]分析中，41份（57.6%）革兰氏涂片阳性（GSP）。在23份（56.1%）涂片中鉴定出革兰氏阳性球菌（GPC），而14份（34.2%）有革兰氏阴性杆菌（GNB）。只有3份（7.3%）有革兰氏阴性双球菌（GND）。尽管有确凿的生化检查结果，但其余30份（42.3%），包括2例结核性脑膜炎病例，涂片为阴性。GPC病例的平均年龄为4.49±5.3岁，GNB病例为3.06±4.8岁，GND病例为4.47±4.9岁。28例（39.4%）病例获得了脑脊液分离株。肺炎链球菌占主导地位，为22例（78.6%）（P = 0.00），流感嗜血杆菌为2例（7.1%），脑膜炎奈瑟菌仅1例（3.5%）。虽然肺炎链球菌和流感嗜血杆菌分离株对舒他西林、头孢呋辛、头孢曲松和头孢他啶均呈一致敏感，但7.7%的肺炎链球菌对结晶青霉素耐药，6.7%对氨苄西林耐药，69.2%对氯霉素耐药；2例流感嗜血杆菌分离株中有1例对氯霉素耐药。在30例（42.3%）死亡病例中，GNB阳性病例的住院时间明显较短（P = 0.045）。入院时脑脊液为脓性/浑浊的病例死亡率明显较高（P = 0.03），脑脊液蛋白>150mg/dl（P = 0.02）和葡萄糖<1mg/dl（P = 0.047）的病例死亡率也明显较高。在我们的研究人群中目前GPC和肺炎链球菌的病因学优势、高病死率以及新出现的耐药情况表明需要探索包括疫苗接种在内的其他控制措施。我们强调需要定期审核CPM的当地抗菌政策。
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