Namani Sadie, Koci Remzie, Dedushi Kreshnike
Clinic of Infectious Diseases, University Hospital Center of Kosova, Prishtinë, Kosova.
Turk J Pediatr. 2010 Jul-Aug;52(4):354-9.
Even when highly effective antibiotic therapy is provided to patients, death and long-term disabilities are common outcomes of acute bacterial meningitis (BM) in developing countries. The aim of this study was to analyze how the outcome of disease was related to the initial antimicrobial therapy used to treat the patients. We analyzed 277 children younger than 16 years of age who were treated for BM in the Hospital of Infectious Diseases in Prishtina, Kosova, over a six-year period. Of the 277 children treated for BM, 36.1% of cases were given initial antimicrobial therapy with one antibiotic, 63.2% of cases received two antibiotics and 0.7% of the cases received three antibiotics. Of the 60 patients who had neurologic complications (NC), 50 (28.6%) were treated with two antibiotics, 9 (9%) received one antibiotic and 1 patient was treated with three antibiotics. The antibiotics used most often as monotherapy were penicillin G (63 cases) and ceftriaxone (33 cases). The incidence of NC was higher in children treated with ceftriaxone (NC=22%, mortality [M]=3%) compared with patients treated with penicillin G (NC=3%, M=0). The most commonly used combination of antibiotics was ceftriaxone with chloramphenicol (82 cases) followed by penicillin G with chloramphenicol (63 cases). The incidences of NC and M were higher in children treated with ceftriaxone and chloramphenicol (NC=43%, M=8%) compared to children treated with penicillin G and chloramphenicol (NC=13%, M=3%). The initial treatment of BM with penicillin G did not result in death and was associated with a lower incidence of NC compared with the use of ceftriaxone. The combination of penicillin G and chloramphenicol resulted in a lower incidence of NC and M compared with the combination of ceftriaxone and chloramphenicol.
即使为患者提供了高效的抗生素治疗，在发展中国家，急性细菌性脑膜炎（BM）的常见后果仍是死亡和长期残疾。本研究的目的是分析疾病的转归与用于治疗患者的初始抗菌治疗之间的关系。我们分析了科索沃普里什蒂纳传染病医院在六年期间收治的277名16岁以下因BM接受治疗的儿童。在277例接受BM治疗的儿童中，36.1%的病例接受了一种抗生素的初始抗菌治疗，63.2%的病例接受了两种抗生素治疗，0.7%的病例接受了三种抗生素治疗。在60例有神经系统并发症（NC）的患者中，50例（28.6%）接受了两种抗生素治疗，9例（9%）接受了一种抗生素治疗，1例患者接受了三种抗生素治疗。最常作为单一疗法使用的抗生素是青霉素G（63例）和头孢曲松（33例）。与接受青霉素G治疗的患者（NC = 3%，死亡率[M] = 0）相比，接受头孢曲松治疗的儿童中NC的发生率更高（NC = 22%，M = 3%）。最常用的抗生素组合是头孢曲松与氯霉素（82例），其次是青霉素G与氯霉素（63例）。与接受青霉素G和氯霉素治疗的儿童（NC = 13%，M = 3%）相比，接受头孢曲松和氯霉素治疗的儿童中NC和M的发生率更高（NC = 43%，M = 8%）。与使用头孢曲松相比，用青霉素G对BM进行初始治疗未导致死亡，且与较低的NC发生率相关。与头孢曲松和氯霉素的组合相比，青霉素G和氯霉素的组合导致NC和M的发生率较低。
