疑似化脓性脑膜炎患者在 Hawassa 大学医院的抗生素敏感性分析及细菌分离情况：一项横断面研究。
Antimicrobial sensitivity profile and bacterial isolates among suspected pyogenic meningitis patients attending at Hawassa University Hospital: Cross-sectional study.
机构信息
School of Medical Laboratory Science, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
Department of Internal Medicine, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
出版信息
BMC Microbiol. 2020 May 19;20(1):125. doi: 10.1186/s12866-020-01808-5.
BACKGROUND
Bacterial meningitis is a serious inflammation of the meninges. Antimicrobial therapy on early cerebrospinal fluid (CSF) examination has an important role in diagnosis. The disease is still challenging in developing countries because of poor (diagnostic set-up, socioeconomic conditions, management), and misuse of antimicrobial therapy results in emerging antimicrobial-resistant strains. Therefore, this hospital based cross sectional study was aimed to assess the antimicrobial sensitivity profile and bacterial isolates among patients suspected of pyogenic meningitis at Hawassa University Hospital from February 2017 to 2018.
RESULTS
A total of 394 patients suspected as meningitis were included. Of these 210 (53.3%) were males and 184 (46.7%) were females. The carriage rate of bacterial pathogens was 27(6.9%). The common clinical presentations were fever 330 (83.8%), headache 205 (52.0%) and neck stiffness 179(45.4%) followed by altered mental status 125(31.7%). Neck stiffness P = 0.001 (AOR = 1.18, 95% CI 1.06-6.53), Hx of seizure P = 0.043, (AOR = 1.39, 95% CI 1.15-5.99), Nuchal rigidity P = 0.001* (AOR = 1.26, 95% CI 1.06-4.48) were significantly associated with culture positivity. The pathogens isolated in this study were N. meningitidis the most frequent isolate 12(44.4%) followed by S. pneumoniae 5 (18.5%), E. coli 4(14.8%), H. influenza 3(13.6%), S. aureus 2(11.1%) and K. pneumoniae 1(3.7%). S. pneumoniae was (100%) resistance to penicillin, (80%) amoxicillin, and (20%) Cefotaxime. S. aureus was (100%) resistant to penicillin, amoxicillin, and ciprofloxacin. N. meningitidis was (100%) resistant to penicillin, (66.7%) Ceftriaxone and (41.7%) chloramphenicol. In this study a single isolate was also resistant to a different antibiotic.
CONCLUSION
The prevention of bacterial meningitis needs serious attention since the isolated bacteria showed single and multiple antimicrobial susceptibility patterns and the variable nature of isolated etiological agents makes it reasonable to provide continuous future updates on local resistance of common antibiotics and optimize the most frequent bacteria associated with meningitis in the hospital. Therefore; further, survey study with a better design of antimicrobial susceptibility at large scale to control the spread of antibiotic-resistant bacteria and the change in the causative organism of bacterial meningitis in the study area and at a national level is required.
背景
细菌性脑膜炎是脑膜的严重炎症。早期脑脊液（CSF）检查中的抗菌治疗在诊断中具有重要作用。由于诊断设备不完善、社会经济条件差、管理不善以及抗菌治疗的滥用，该疾病在发展中国家仍然具有挑战性，导致出现了对抗菌药物具有耐药性的菌株。因此，本项在 2017 年 2 月至 2018 年期间在 Hawassa 大学医院进行的基于医院的横断面研究旨在评估疑似化脓性脑膜炎患者的抗菌敏感性谱和细菌分离株。
结果
共纳入 394 例疑似脑膜炎患者。其中 210 例（53.3％）为男性，184 例（46.7％）为女性。细菌病原体的携带率为 27（6.9％）。常见的临床症状为发热 330 例（83.8％），头痛 205 例（52.0％）和颈部僵硬 179 例（45.4％），其次是精神状态改变 125 例（31.7％）。颈部僵硬 P=0.001（AOR=1.18，95％CI 1.06-6.53），癫痫发作史 P=0.043（AOR=1.39，95％CI 1.15-5.99），颈项强直 P=0.001*（AOR=1.26，95％CI 1.06-4.48）与培养阳性显著相关。本研究中分离出的病原体中，脑膜炎奈瑟菌最常见，为 12 株（44.4％），其次是肺炎链球菌 5 株（18.5％），大肠杆菌 4 株（14.8％），流感嗜血杆菌 3 株（13.6％），金黄色葡萄球菌 2 株（11.1％）和肺炎克雷伯菌 1 株（3.7％）。肺炎链球菌对青霉素（100％）、阿莫西林（80％）和头孢噻肟（20％）具有耐药性。金黄色葡萄球菌对青霉素、阿莫西林和环丙沙星（100％）具有耐药性。脑膜炎奈瑟菌对青霉素（100％）、头孢曲松（66.7％）和氯霉素（41.7％）具有耐药性。在本研究中，还发现了一种单一的耐药菌，对不同的抗生素具有耐药性。
结论
由于分离的细菌表现出单一和多种抗菌敏感性模式，并且分离的病原体的性质不同，因此需要认真注意预防细菌性脑膜炎，这使得不断提供有关常见抗生素的当地耐药性的最新信息并优化与医院中脑膜炎相关的最常见细菌变得合理。因此，需要在更大范围内进行更好设计的抗菌药物敏感性调查研究，以控制耐药菌的传播，并改变研究区域和全国范围内细菌性脑膜炎的病原体。
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