From Internal Medicine and Infectious Disease Service, New Mexico VA Health Care System, 1501 San Pedro Dr. SE, Albuquerque, NM, 87108, USA,
Curr Treat Options Neurol. 2013 Aug;15(4):477-91. doi: 10.1007/s11940-013-0244-7.
The burden of disease due to bacterial meningitis is shifting toward older adults. Clinicians should maintain a high level of suspicion of meningitis in older adults, since they may present without classic signs and symptoms. Clinicians should remember that more older patients are at risk of healthcare-associated meningitis and may be at risk of more resistant organisms. A lumbar puncture should be performed as quickly as possible. If a CT scan is required before the lumbar puncture, blood cultures should be drawn and appropriate empiric antibiotics should be started before sending the patient to the CT scanner. Empiric antibiotics should be chosen based on patient history, review of patient's known illnesses and risk factors, results of CSF Gram stain, and local institution antibiotic resistance patterns. Clinicians should remember that Streptococcus pneumoniae may be resistant to penicillin and cephalosporins, so vancomycin is usually also administered until the bacterial resistance pattern is known. Adjunctive dexamethasone may be started before or at the time of antibiotic therapy based on risk versus benefit analysis, and may be discontinued if patient is found to not have Streptococcus pneumoniae meningitis.
细菌性脑膜炎导致的疾病负担正在向老年人转移。临床医生应保持对老年人脑膜炎的高度怀疑，因为他们可能没有典型的体征和症状。临床医生应记住，更多的老年患者有患与医疗保健相关的脑膜炎的风险，并且可能有更多耐药的病原体。应尽快进行腰椎穿刺。如果在腰椎穿刺前需要进行 CT 扫描，则应在将患者送往 CT 扫描仪前抽取血培养，并开始使用经验性抗生素。应根据患者病史、患者已知疾病和危险因素的回顾、CSF 革兰氏染色结果以及当地机构抗生素耐药模式来选择经验性抗生素。临床医生应记住，肺炎链球菌可能对青霉素和头孢菌素耐药，因此在细菌耐药模式明确之前，通常还会给予万古霉素。根据风险与获益分析，辅助地塞米松可在开始抗生素治疗之前或同时开始，并且如果发现患者没有肺炎链球菌脑膜炎，则可以停止使用。
