Tan Ying Ching, Gill Arshdeep Kaur, Kim Kwang Sik
Johns Hopkins University School of Medicine, Division of Pediatric Infectious Diseases , 200 North Wolfe Street, Baltimore, MD 21287 , USA.
Expert Opin Pharmacother. 2015 Feb;16(2):187-203. doi: 10.1517/14656566.2015.973851. Epub 2014 Oct 18.
Central nervous system infection continues to be an important cause of mortality and morbidity worldwide. Our incomplete knowledge on the pathogenesis of how meningitis-causing pathogens cause CNS infection and emergence of antimicrobial resistance has contributed to the mortality and morbidity. An early empiric antibiotic treatment is critical for the management of patients with bacterial meningitis, but early recognition of bacterial meningitis continues to be a challenge.
This review gives an overview on current therapeutic strategies for CNS infection with a focus on recent literature since 2010 on bacterial meningitis. Bacterial meningitis is a medical emergency, requiring early recognition and treatment. The selection of appropriate empiric antimicrobial regimen, after incorporating the epidemiology of bacterial meningitis, impact of vaccination, emergence of antimicrobial-resistant bacteria, role of adjunctive therapy and the current knowledge on the pathogenesis of meningitis and associated neuronal injury are covered.
Prompt treatment of bacterial meningitis with an appropriate antibiotic is essential. Optimal antimicrobial treatment of bacterial meningitis requires bactericidal agents able to penetrate the blood-brain barrier, with efficacy in cerebrospinal fluid. Emergence of CNS-infecting pathogens with resistance to conventional antibiotics has been increasingly recognized, but development of new antibiotics has been limited. More complete understanding of the microbial and host factors that are involved in the pathogenesis of bacterial meningitis and associated neurologic sequelae is likely to help in developing new strategies for the prevention and therapy of bacterial meningitis.
中枢神经系统感染仍是全球范围内死亡率和发病率的重要原因。我们对引起脑膜炎的病原体如何导致中枢神经系统感染以及抗菌药物耐药性出现的发病机制了解不全面，这导致了死亡率和发病率居高不下。早期经验性抗生素治疗对于细菌性脑膜炎患者的管理至关重要，但细菌性脑膜炎的早期识别仍然是一项挑战。
本综述概述了中枢神经系统感染的当前治疗策略，重点关注自2010年以来关于细菌性脑膜炎的最新文献。细菌性脑膜炎是一种医疗急症，需要早期识别和治疗。文中涵盖了在考虑细菌性脑膜炎的流行病学、疫苗接种的影响、抗菌耐药菌的出现、辅助治疗的作用以及当前关于脑膜炎发病机制和相关神经元损伤的知识后，选择合适的经验性抗菌治疗方案的内容。
及时使用合适的抗生素治疗细菌性脑膜炎至关重要。细菌性脑膜炎的最佳抗菌治疗需要能够穿透血脑屏障且在脑脊液中有效的杀菌剂。对传统抗生素耐药的中枢神经系统感染病原体的出现已越来越受到认可，但新抗生素的研发一直有限。更全面地了解参与细菌性脑膜炎发病机制及相关神经后遗症的微生物和宿主因素，可能有助于制定细菌性脑膜炎预防和治疗的新策略。
