Gram-negative bacillary meningitis after cranial surgery or trauma in adults
Gram-negative bacillary meningitis after cranial surgery or trauma in adults
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DOI：
10.1080/00365540410027193
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发表时间：
2004-04-01
影响因子：
--
通讯作者：
Wilkinson, L
中科院分区：
文献类型：
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作者：
Briggs, S;Ellis-Pegler, R;Wilkinson, L
为了评估神经外科手术后和创伤后革兰氏阴性杆菌性脑膜炎（GNBM）的临床特征、病因、治疗和结局，我们对所有在神经外科手术或创伤性头部/脊柱损伤后从脑脊液（CSF）中培养出革兰氏阴性杆菌的住院神经外科成人患者进行了回顾性分析。在12年的审查期间，33例患者的CSF分离出的革兰氏阴性杆菌被认为是重要的。患者中位年龄为47岁（范围22-77岁），21例（64%）为男性。肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌是最常见的分离株。半数患者分离株的最小抑菌浓度（MIC）测定导致5例方案改变，包括2例E。在头孢菌素治疗期间头孢菌素敏感性降低的肺炎性脑膜炎。我们推荐的初始治疗是静脉注射头孢曲松和阿米卡星，随后根据药敏结果进行调整;大约一半的患者继续使用他们开始使用的抗生素，一半改为替代方案，最常见的是碳青霉烯。5例患者（15%）死亡，1例在治愈GNBM后死亡。接受适当治疗超过12天的患者中没有失败：在最后一次阳性CSF培养后至少治疗14天可保证治愈。最初的头孢曲松和阿米卡星随后改变为敏感性驱动的替代品，通常是碳青霉烯，导致85%的GNBM患者治愈。
In order to assess the clinical features, aetiology, treatment and outcome of post-neurosurgical and post-traumatic Gram-negative bacillary meningitis (GNBM) we performed a retrospective review of all adult patients admitted to the Department of Neurosurgery who had Gram-negative bacilli cultured from cerebrospinal fluid (CSF) following a neurosurgical procedure or traumatic head/spinal injury. During the 12 y of the review 33 patients had CSF isolates of Gram-negative bacilli that were thought to be significant. The median patient age was 47 y (range 22-77 y) and 21 (64%) were male. Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli were the most common isolates. Minimal inhibitory concentrations (MIC) measured for half the patients' isolates resulted in 5 regimen changes, including 2 patients with E. cloacae meningitis in whom cephalosporin susceptibility decreased during cephalosporin treatment. Our recommended initial treatment was intravenous ceftriaxone and amikacin, subsequently tailored by susceptibility results; approximately half the patients remained on the antibiotics they started and half were changed to an alternate regimen, most often a carbapenem. Five patients (15%) died, 1 dying after cure of his GNBM. There were no failures in those who received more than 12 d of appropriate treatment: treatment for at least 14 d after the last positive CSF culture guaranteed cure. Initial ceftriaxone and amikacin subsequently changing to susceptibility driven alternatives, often a carbapenem, resulted in cure of 85% of our patients with GNBM.