O'Neill E, Humphreys H, Phillips J, Smyth E G
Department of Microbiology, Beaumont Hospital, and Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 9, Ireland.
J Antimicrob Chemother. 2006 Feb;57(2):356-9. doi: 10.1093/jac/dki462. Epub 2005 Dec 20.
The treatment of meningitis caused by Gram-negative bacilli in neurosurgical patients is a major challenge because of the complexity of these patients, the emergence of antibiotic resistance in many of the causative organisms and the restricted choice of antibiotics suitable for use, owing to a failure to achieve high enough concentrations in the CSF. We reviewed the incidence, aetiology, treatment and outcome of all patients with Gram-negative bacillary meningitis (GNBM) in our centre over a 7 year period.
Beaumont Hospital, Dublin is a 720 bed tertiary referral hospital and contains the national neurosurgical centre for the Republic of Ireland. The case notes and microbiological records of all patients with GNBM between 1998 and 2004 inclusive were reviewed retrospectively. Only patients with positive CSF culture and clinical features compatible with meningitis were included.
Forty separate episodes of GNBM involving 34 different patients occurred during the study period. The most common causative organisms were Enterobacter spp. (35%), Escherichia coli (22.5%) and Pseudomonas aeruginosa (15%). Twenty-five per cent of isolates were resistant to third-generation cephalosporins. The median duration of treatment was 19.2 days and a combination of intravenous and intraventricular antibiotics was the most common treatment regimen used. Mortality directly related to GNBM was 2.5%.
Although the mortality directly related to GNBM was low, the emergence of strains resistant to third-generation cephalosporins represents a therapeutic challenge. Treatment with combined intravenous and intraventricular antibiotics is recommended for 2-3 weeks, but more studies are required to determine the optimal management of this difficult condition.
由于神经外科患者情况复杂，许多致病微生物出现抗生素耐药性，且因脑脊液中无法达到足够高的浓度而导致适合使用的抗生素选择受限，革兰氏阴性杆菌引起的脑膜炎的治疗是一项重大挑战。我们回顾了本中心7年间所有革兰氏阴性杆菌性脑膜炎（GNBM）患者的发病率、病因、治疗及转归情况。
都柏林博蒙特医院是一家拥有720张床位的三级转诊医院，设有爱尔兰共和国国家神经外科中心。对1998年至2004年（含）期间所有GNBM患者的病历和微生物学记录进行回顾性分析。仅纳入脑脊液培养阳性且有与脑膜炎相符临床特征的患者。
在研究期间共发生40例独立的GNBM发作，涉及34例不同患者。最常见的致病微生物是肠杆菌属（35%）、大肠埃希菌（22.5%）和铜绿假单胞菌（15%）。25%的分离株对第三代头孢菌素耐药。治疗的中位持续时间为19.2天，静脉和脑室内联合使用抗生素是最常用的治疗方案。与GNBM直接相关的死亡率为2.5%。
虽然与GNBM直接相关的死亡率较低，但对第三代头孢菌素耐药菌株的出现构成了治疗挑战。建议静脉和脑室内联合使用抗生素治疗2至3周，但需要更多研究来确定这种疑难病症的最佳治疗方法。
