Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Lancet Infect Dis. 2010 Jan;10(1):32-42. doi: 10.1016/S1473-3099(09)70306-8.
Bacterial meningitis continues to be an important cause of mortality and morbidity in neonates and children throughout the world. The introduction of the protein conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has changed the epidemiology of bacterial meningitis. Suspected bacterial meningitis is a medical emergency and needs empirical antimicrobial treatment without delay, but recognition of pathogens with increasing resistance to antimicrobial drugs is an important factor in the selection of empirical antimicrobial regimens. At present, strategies to prevent and treat bacterial meningitis are compromised by incomplete understanding of the pathogenesis. Further research on meningitis pathogenesis is thus needed. This Review summarises information on the epidemiology, pathogenesis, new diagnostic methods, empirical antimicrobial regimens, and adjunctive treatment of acute bacterial meningitis in infants and children.
细菌性脑膜炎仍然是全世界新生儿和儿童死亡和发病的重要原因。针对流感嗜血杆菌 b 型、肺炎链球菌和脑膜炎奈瑟菌的蛋白结合疫苗的问世改变了细菌性脑膜炎的流行病学。疑似细菌性脑膜炎是一种医疗急救，需要立即进行经验性抗菌治疗，但病原体对抗菌药物的耐药性不断增加是选择经验性抗菌方案的一个重要因素。目前，预防和治疗细菌性脑膜炎的策略因对发病机制的认识不完整而受到影响。因此，需要进一步研究脑膜炎的发病机制。本综述总结了婴儿和儿童急性细菌性脑膜炎的流行病学、发病机制、新的诊断方法、经验性抗菌方案和辅助治疗信息。
