Abstract: Objective　To investigate the clinical characteristics and etiologic agents of pediatric purulent meningitis in different age groups， and to offer theoretical basis for the diagnosis and therapy. Methods　A retrospective study of 173 children with the clinical diagnosis of purulent meningitis in the past 5 years was conducted. All patients were divided into four groups according to the age： group1 （newborns，n =48），group2（infants，n =73），group3（1～5 years，n =22），group4（>5 years，n =30）.Results　Low-moderate grade fever was present in 66.7% of newborns in group1. Seizure was a common symptom of bacterial meningitis； the proportions of seizure attack（47/73 64.4% ） and bulging fontanel（43/73 58.9%） in group2 were the highest among all groups（P <0.01）. In group2 42/73（57.5%） and 15/73（20.6%） of the cases survived with complications and neurologic sequelae， and the incidence of empirical therapy modification was 33/73（45.2%）， which were higher than those in other groups（P <0.01）； 28/30（93.3%） cases had headache and signs of meningeal irritation in group4， the rates of them being significantly higher than other groups（P <0.01）; 8/30（27.3%） cases were associated with cerebrospinal fluid leaks and neurosurgical procedures in group 4；63 strains of pathogenic bacteria from 173 CSF specimens were identified， the positive culture rate being 36.4%. The most predominant pathogens in each group were Escherichia Coli， coagulase-negative staphylococcus， Neisseria meningitides and streptococcus pneumoniae， respectively. Conclusion　Etiology of purulent meningitis is affected most by the age of the children， and manifestations depend on the age too. Age of patient with purulent meningitis should be considered in the diagnosis and therapy.

Key words: pathogen , bacterial meningitis

摘要： 了解不同年龄阶段儿童化脓性脑膜炎临床表现和致病菌的差异，为临床诊治提供依据。方法 　回顾分析天津市儿童医院2004年1月至2008年12月诊 断的173例儿童化脓性脑膜炎的临床资料，并按发病年龄分为4组，第1组为生后5～28 d的新生儿48例（27.8%），第2组为＞28 d～12月龄婴儿73例（42.2%），第 3组为＞1～5岁幼儿22例（12.7%），第4组为>5岁儿童30例（17.3%），比较4组临床特点及主要致病菌差异。结果　第1组66.7%患儿表现低热或中等程度发热，症 状体征不典型。第2组抽搐、前囟膨隆、更改经验治疗、合并症发生率高于其他3组（P <0.01）。第3组临床特点介于婴儿期和儿童期之间。第4组脑膜刺激征、头 疼发生率高于其他各组，均为93.3%（P <0.01），且第4组伴发身体解剖结构的缺陷所致脑脊液漏或外科手术后患者多达27.3%。63例脑脊液致病菌培养阳性，总 阳性率36.4%，各组第1位致病菌分别为大肠埃希菌、凝固酶阴性葡萄球菌、脑膜炎奈瑟菌和肺炎链球菌。结论　儿童化脓性脑膜炎不同年龄阶段的临床表现各有 特点，致病菌谱也存在一定差异。临床诊治应根据发病年龄区别对待，提高针对性。

关键词: 儿童, 细菌性脑膜炎, 致病菌