Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes
Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes
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DOI：
10.1016/j.jocn.2004.09.017
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发表时间：
2005-08-01
影响因子：
2
通讯作者：
Lu, CH
中科院分区：
文献类型：
--
作者：
Wang, KW;Chang, WN;Lu, CH
研究人员回顾性收集了 16 年来 62 名患有神经外科术后院内细菌性脑膜炎的成年患者的临床数据。案件根据提交日期分为两组，第一组为1986-1993年，第二组为1994-2001年。发烧和进行性意识障碍是最一致的临床特征——这些迹象也可能归因于其他术后神经外科问题。常见病原菌有金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、大肠杆菌、鲍曼不动杆菌等。在第二阶段，多种微生物感染和多种抗生素耐药性有所增加。研究前半期的死亡率为 22%，下半年为 36%。成人神经外科术后医院细菌性脑膜炎已成为重要的临床问题。选择适当的经验性抗生素具有挑战性，必须以了解各种病原体的相对频率和耐药菌株发病率的增加为指导。尽管高死亡率可能部分与原发性脑部病理有关，但基于抗菌药物敏感性测试的早期诊断和及时使用抗生素对于生存至关重要。 (C) 2005 Elsevier Ltd. 保留所有权利。
The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multiantibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival. (C) 2005 Elsevier Ltd. All rights reserved.