Brouwer M C, van de Beek D
Department of Neurology, Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurology, Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Handb Clin Neurol. 2017;140:349-364. doi: 10.1016/B978-0-444-63600-3.00019-2.
Bacterial infections of the central nervous system present as a medical emergency, thus requiring rapid diagnosis and immediate treatment. The most prevalent bacterial infections seen in the intensive care unit can be summarized as acute bacterial meningitis, subdural empyema, intracerebral abscess, and ventriculitis, which all commonly involve the brain parenchyma. The infections can either be community-acquired or hospital-acquired, e.g., after neurosurgical intervention, as a complication of severe neurotrauma or related to indwelling cerebrospinal fluid drains. Community-acquired bacterial meningitis is most commonly caused by the pneumococcus (Streptococcus pneumoniae) and meningococcus (Neisseria meningtidis), and is often complicated by hearing loss, cerebrovascular complications, and seizures. Brain abscesses are frequently associated with contiguous or metastatic foci of infection such as otitis, sinusitis, pneumonia, or endocarditis which need to be detected and treated early during disease course. Despite optimal treatment, many patients are at risk for both major systemic and neurologic complications, leading to a substantial mortality and risk of major disability in survivors. Empiric treatment depends on regional antibiotic resistance patterns of common pathogens. For subdural empyema and brain abscesses, neurosurgical drainage of the infection is required alongside prolonged antibiotic treatment.
中枢神经系统细菌感染属于医疗急症，因此需要快速诊断和立即治疗。重症监护病房中最常见的细菌感染可概括为急性细菌性脑膜炎、硬膜下积脓、脑脓肿和脑室炎，这些感染通常都累及脑实质。感染可通过社区获得，也可在医院获得，例如在神经外科手术后、作为严重神经创伤的并发症或与留置脑脊液引流管有关。社区获得性细菌性脑膜炎最常见的病因是肺炎球菌（肺炎链球菌）和脑膜炎球菌（脑膜炎奈瑟菌），常伴有听力丧失、脑血管并发症和癫痫发作。脑脓肿常与邻近或转移性感染灶相关，如中耳炎、鼻窦炎、肺炎或心内膜炎，在病程早期就需要检测和治疗。尽管进行了最佳治疗，许多患者仍有发生严重全身和神经并发症的风险，导致相当高的死亡率和幸存者出现严重残疾的风险。经验性治疗取决于常见病原体的区域抗生素耐药模式。对于硬膜下积脓和脑脓肿，除了延长抗生素治疗外，还需要进行神经外科引流感染。
