Khalifa A Ben Haj, Mastouri M, Abdallah H Ben, Noomen S, Kheder M
Laboratoire de microbiologie de l'hôpital Tahar-Sfar, 5100 Mahdia, Tunisie.
Bull Soc Pathol Exot. 2011 Feb;104(1):42-8. doi: 10.1007/s13149-010-0077-5. Epub 2010 Sep 10.
The aim of this study was to analyze the distribution of bacteria responsible for purulent meningitis and the pattern of resistance of common species in the University Hospital of Monastir (Tunisia). All bacteriologically confirmed cases of bacterial meningitis were recorded between 1999 and 2006, and have been analyzed by classic bacterial methods advocate for meningitis. Two hundred fifty three strains have been isolated. The most frequent species were Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae, followed by Escherichia coli and Neisseria meningitides with 19.4, 13.8, 13.8, 7.1, and 6.3% of cases, respectively. Their distribution with regard to age was in accordance with literature data. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteriaceae and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. Influenzae was the predominant microorganism in children between three month and five years of age (36.3%), followed by S. Pneumoniae (28.8%). S. Pneumoniae was the predominant bacteria responsible for 47% of the cases over five years of age. 38.8% of S. Pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were 4.1%, respectively. Only one strain of N. meningitidis (6.2%) presented a decreased susceptibility to penicillin. 22.9% of H. Influenzae strains produced β-lactamase. The resistance rates of Enterobacteriaceae to third generation cephalosporins were 25%. In our study, nosocomial meningitis have shown a rate of 24.4%. The most affected service was neurosurgery, pediatrics, and intensive care units. The increasing prevalence of pneumococci meningitis with reduced sensitivity to penicillin G strains isolated from meningitis makes adequate therapeutic management difficult.
本研究旨在分析突尼斯莫纳斯提尔大学医院化脓性脑膜炎致病细菌的分布情况以及常见菌种的耐药模式。1999年至2006年间记录了所有经细菌学确诊的细菌性脑膜炎病例，并采用经典的脑膜炎细菌检测方法进行分析。共分离出253株菌株。最常见的菌种是肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌，其次是大肠杆菌和脑膜炎奈瑟菌，分别占病例的19.4%、13.8%、13.8%、7.1%和6.3%。它们在各年龄段的分布与文献数据相符。这些细菌的年度分布未显示出任何流行高峰。肠杆菌科细菌和B组链球菌是新生儿脑膜炎中最常见的病原体。流感嗜血杆菌是3个月至5岁儿童中的主要微生物（36.3%），其次是肺炎链球菌（28.8%）。肺炎链球菌是5岁以上病例中47%的主要致病菌。38.8%的肺炎链球菌菌株对青霉素敏感性降低。阿莫西林和头孢噻肟的耐药率分别为4.1%。仅1株脑膜炎奈瑟菌（6.2%）对青霉素敏感性降低。22.9%的流感嗜血杆菌菌株产生β-内酰胺酶。肠杆菌科细菌对第三代头孢菌素的耐药率为25%。在我们的研究中，医院获得性脑膜炎的发生率为24.4%。受影响最严重的科室是神经外科、儿科和重症监护病房。从脑膜炎中分离出的对青霉素G敏感性降低的肺炎球菌性脑膜炎患病率不断上升，这使得进行充分的治疗管理变得困难。
