Klugman K P, Madhi S A
School of Pathology, South African Institute for Medical Research, University of the Witwatersrand, Johannesburg, South Africa.
Infect Dis Clin North Am. 1999 Sep;13(3):637-46, vii. doi: 10.1016/s0891-5520(05)70098-2.
Antimicrobial resistance has emerged among the three major bacterial pathogens causing meningitis. Chloramphenicol resistance in the meningococcus recently has been described, and although intermediate penicillin resistance is common in some countries, the clinical importance of penicillin resistance in the meningococcus has yet to be established. Beta-lactamase-producing Haemophilus influenzae are relatively common, and chloramphenicol resistance is emerging. Third-generation cephalosporins are required to treat meningitis caused by these resistant strains. Pneumococcus resistance to penicillin and to chloramphenicol is widespread, and resistance to third-generation cephalosporins is found in many parts of the world. Correct management of these strains includes the addition of vancomycin or rifampin to therapy with third-generation cephalosporins.
引起脑膜炎的三种主要细菌病原体已出现耐药性。最近已报道脑膜炎奈瑟菌对氯霉素耐药，尽管在一些国家中度青霉素耐药很常见，但脑膜炎奈瑟菌青霉素耐药的临床重要性尚未明确。产β-内酰胺酶的流感嗜血杆菌相对常见，且对氯霉素的耐药性也在出现。治疗由这些耐药菌株引起的脑膜炎需要使用第三代头孢菌素。肺炎球菌对青霉素和氯霉素的耐药很普遍，在世界许多地区都发现了对第三代头孢菌素的耐药情况。对这些菌株的正确处理包括在第三代头孢菌素治疗中加用万古霉素或利福平。
