Nigrovic Lise E, Malley Richard, Macias Charles G, Kanegaye John T, Moro-Sutherland Donna M, Schremmer Robert D, Schwab Sandra H, Agrawal Dewesh, Mansour Karim M, Bennett Jonathan E, Katsogridakis Yiannis L, Mohseni Michael M, Bulloch Blake, Steele Dale W, Kaplan Ron L, Herman Martin I, Bandyopadhyay Subhankar, Dayan Peter, Truong Uyen T, Wang Vince J, Bonsu Bema K, Chapman Jennifer L, Kuppermann Nathan
Children's Hospital Boston and Harvard Medical School,, Boston, MA 02115, USA.
Pediatrics. 2008 Oct;122(4):726-30. doi: 10.1542/peds.2007-3275.
The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis.
We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture.
We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with >or=12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for <12 hours, had significantly higher median cerebrospinal fluid glucose levels (48 mg/dL vs 29 mg/dL) and lower median cerebrospinal fluid protein levels (121 vs 178 mg/dL).
In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.
本研究的目的是评估腰椎穿刺前使用抗生素对细菌性脑膜炎患儿脑脊液特征的影响。
我们回顾了2001年至2004年间在20个儿科急诊科就诊的所有细菌性脑膜炎患儿（1个月至18岁）的病历。细菌性脑膜炎的定义为脑脊液培养出细菌病原体阳性，或脑脊液细胞增多且血培养阳性和/或脑脊液乳胶凝集试验结果阳性。疑似细菌性脑膜炎的定义为脑脊液革兰氏染色结果阳性而血和脑脊液细菌培养结果阴性。抗生素预处理定义为在腰椎穿刺前72小时内使用的任何抗生素。
我们确定了231例细菌性脑膜炎患者和另外14例疑似细菌性脑膜炎患者。在这245例患者中，85例（35%）接受了抗生素预处理。在对患者年龄、就诊时疾病的持续时间和严重程度以及细菌病原体进行调整后，抗生素预处理时间较长与脑脊液白细胞计数、脑脊液绝对中性粒细胞计数无显著相关性。然而，抗生素预处理与脑脊液葡萄糖水平较高和脑脊液蛋白水平较低显著相关。尽管这些影响更早显现，但预处理时间≥12小时的患者与未预处理或预处理时间<12小时的患者相比，脑脊液葡萄糖中位数水平显著更高（48mg/dL对29mg/dL），脑脊液蛋白中位数水平显著更低（121对178mg/dL）。
在细菌性脑膜炎患者中，抗生素预处理与脑脊液葡萄糖水平较高和脑脊液蛋白水平较低相关，尽管预处理不会改变脑脊液白细胞计数或绝对中性粒细胞计数结果。
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