Kim J H, van der Horst C, Mulrow C D, Corey G R
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710.
Rev Infect Dis. 1989 Sep-Oct;11(5):698-706. doi: 10.1093/clinids/11.5.698.
Staphylococcus aureus is a relatively uncommon cause of meningitis associated with high mortality in neonates and neurosurgical patients. The infrequency of this infection has made its study difficult and has complicated the issues of treatment and prognosis. We reviewed 28 cases of S. aureus meningitis occurring over a 10-year period at three hospitals. Eight cases in children and 20 in adults were identified. Seventy-five percent of the children and 35% of the adults had central nervous system trauma or surgery; 45% of adults had comorbid disease that might have predisposed them to infection. Clinical presentation did not distinguish this form of meningitis from other bacterial meningitides. Findings in cerebrospinal fluid were characteristic of acute bacterial meningitis. Blood cultures were positive in 65% of cases. Overall mortality was 37%; 50% of adults but no children died of meningitis. No patients with S. aureus meningitis complicating cerebrospinal fluid shunts died; however, nine of 11 patients with identifiable foci of infection outside the central nervous system died. Only one patient receiving initial treatment with a penicillinase-resistant penicillin died of meningitis, whereas six of 12 patients not so treated died.
金黄色葡萄球菌是新生儿和神经外科患者脑膜炎相对少见的病因，且死亡率较高。这种感染的罕见性使得对其研究困难，并使治疗和预后问题变得复杂。我们回顾了三家医院在10年期间发生的28例金黄色葡萄球菌脑膜炎病例。其中8例为儿童，20例为成人。75%的儿童和35%的成人有中枢神经系统创伤或手术史；45%的成人有可能使其易患感染的合并症。临床表现无法将这种脑膜炎与其他细菌性脑膜炎区分开来。脑脊液检查结果具有急性细菌性脑膜炎的特征。65%的病例血培养呈阳性。总体死亡率为37%；50%的成人死于脑膜炎，但儿童无死亡病例。金黄色葡萄球菌脑膜炎并发脑脊液分流术的患者无死亡；然而，11例中枢神经系统外有可识别感染灶的患者中有9例死亡。仅1例初始接受耐青霉素酶青霉素治疗的患者死于脑膜炎，而12例未接受该治疗的患者中有6例死亡。
