Youssef Fouad G, El-Sakka Hammam, Azab Adel, Eloun Saed, Chapman Gail D, Ismail Tharwat, Mansour Hoda, Hallaj Z, Mahoney Frank
US Naval Medical Research Unit No. 3, Cairo, Egypt.
Ann Epidemiol. 2004 Jan;14(1):44-8. doi: 10.1016/s1047-2797(03)00075-9.
Surveillance for patients with meningitis is a high priority in order to determine the etiology of disease and design prevention strategies. This study presents data on the causes of bacterial meningitis among children <6 years of age treated in a network of hospitals throughout Egypt.
Training was provided to standardize the collection of clinical information and optimize recovery of bacterial pathogens. Bacterial isolates were tested for antimicrobial resistance patterns using Kirby Bauer disk diffusion, E-test and/or Beta-lactamase (BL) testing methods.
Patients with culture-confirmed bacterial meningitis (228 children<6 years) were identified including 89 (39%) patients with H. influenzae (HI), 68 (30%) with Streptococcus pneumoniae (SP), 30 (13%) with N. meningitidis (NM), 18 (8%) with Mycobacterium tuberculosis (MTB) and 23 (10%) with other bacteria. The overall case fatality ratio was high (24%) and increased among children with TB meningitis (56%). The susceptibility for HI to ampicillin (AMP), chloramphenicol (C) and ceftriaxone (CRO) was 21%, 13%, and 100% respectively. The susceptibility for SP to C and CRO was 79% and 100%, respectively.
HI and SP are the leading causes of bacterial meningitis among children in Egypt. The majority of HI strains tested were resistant to AMP or C suggesting the need for routine use of CRO as first line therapy. Among older children TB emerges as a significant cause of bacterial meningitis in Egypt.
对脑膜炎患者进行监测是重中之重，以便确定疾病病因并制定预防策略。本研究呈现了埃及各地医院网络中6岁以下儿童细菌性脑膜炎病因的数据。
提供培训以规范临床信息收集并优化细菌病原体的回收。使用 Kirby Bauer 纸片扩散法、E-test 法和/或β-内酰胺酶（BL）检测法对细菌分离株进行抗菌药物耐药模式检测。
确定了228例6岁以下培养确诊的细菌性脑膜炎患儿，其中89例（39%）为流感嗜血杆菌（HI）感染，68例（30%）为肺炎链球菌（SP）感染，30例（13%）为脑膜炎奈瑟菌（NM）感染，18例（8%）为结核分枝杆菌（MTB）感染，23例（10%）为其他细菌感染。总体病死率较高（24%），结核性脑膜炎患儿的病死率更高（56%）。HI对氨苄西林（AMP）、氯霉素（C）和头孢曲松（CRO）的敏感性分别为21%、13%和100%。SP对C和CRO的敏感性分别为79%和100%。
HI和SP是埃及儿童细菌性脑膜炎的主要病因。大多数检测的HI菌株对AMP或C耐药，这表明有必要常规使用CRO作为一线治疗药物。在年龄较大的儿童中，结核成为埃及细菌性脑膜炎的一个重要病因。
