Gudina Esayas Kebede, Tesfaye Markos, Adane Aynishet, Lemma Kinfe, Shibiru Tamiru, Pfister Hans-Walter, Klein Matthias
Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
Department of Psychiatry, Jimma University, Jimma, Ethiopia.
Trop Med Int Health. 2016 Jul;21(7):870-8. doi: 10.1111/tmi.12720. Epub 2016 May 30.
To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia.
This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records.
A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%.
Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations.
调查埃塞俄比亚教学医院对疑似细菌性脑膜炎患者的当前诊断和治疗策略。
这是一项在埃塞俄比亚不同地区的四家教学医院开展的基于医院的回顾性研究。参与者为14岁及以上因疑似细菌性脑膜炎接受治疗的患者。从临床记录中获取患者的主诉、使用的诊断策略和给予的治疗。
共有425名患者纳入研究；52.7%为男性，83.8%年龄小于50岁。发热、头痛、颈部僵硬和意识障碍是最常见的临床表现；55.5%的患者接受了腰椎穿刺。总体而言，只有96例（22.6%）患者的脑脊液异常符合细菌性脑膜炎。仅14例患者鉴定出致病细菌。头孢曲松被用作经验性治疗的首选药物，单独使用或与其他抗生素联合使用；17.6%的患者还接受了万古霉素治疗。50.4%的患者接受了辅助性地塞米松治疗。
大多数被当作细菌性脑膜炎治疗的患者未接受适当的诊断检查。抗生素的选择未根据患者的具体临床情况进行调整。这种方法可能导致治疗效果不佳并产生抗生素耐药性。疑似细菌性脑膜炎患者的管理应辅以脑脊液分析，并应根据当地证据和当前循证医学建议进行治疗。
