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儿童确诊为细菌性脑膜炎患者中万古霉素根据类固醇剂量的反应

Response of Vancomycin according to Steroid Dosage in Pediatric Patients with Culture-Proven Bacterial Meningitis.

作者信息

Lee Shin Ae, Kim Jin Kyu, Jo Dae Sun, Kim Sun Jun

机构信息

Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.

Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.

出版信息

Infect Chemother. 2017 Dec;49(4):262-267. doi: 10.3947/ic.2017.49.4.262.

DOI:10.3947/ic.2017.49.4.262
PMID:29299893
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5754336/
Abstract

BACKGROUND

This study aimed to evaluate the efficacy of combined vancomycin and steroid therapy for the treatment of culture-proven bacterial meningitis in pediatric patients.

MATERIALS AND METHODS

We identified a total of 86 pediatric patients with culture-positive cerebrospinal fluid who were treated at our facility between 2005 and 2015. Ten of these patients (5 boys and 5 girls) received first-line treatment with vancomycin as the initial form of therapy. All cultured bacteria were sensitive to vancomycin. We retrospectively analyzed these cases to examine the relationship between concomitant steroid dosage and antibiotic treatment effectiveness.

RESULTS

Nine of the 10 patients included in our analysis received steroid treatment. Of these, 3 received high-dose steroid therapy and 6 received low-dose steroid therapy. Five patients did not respond to vancomycin, including all 3 patients in the high-dose steroid group and 2 patients in the low-dose steroid group. Our analysis confirmed that the response rate to vancomycin treatment was significantly reduced in accordance with steroid dosage (P = 0.035). Patients who did not to respond to vancomycin with concomitant high-dose steroid administration improved clinically after the substitution of vancomycin with teicoplanin.

CONCLUSION

The use of steroids, especially in high doses, may impair the effectiveness of vancomycin for treating bacterial meningitis in pediatric patients. Physicians should be cautious when administering concomitant steroid therapy and should carefully monitor the steroid dosage.

摘要

背景

本研究旨在评估万古霉素与类固醇联合治疗对确诊为细菌性脑膜炎的儿科患者的疗效。

材料与方法

我们确定了2005年至2015年间在我们机构接受治疗的86例脑脊液培养呈阳性的儿科患者。其中10例患者（5名男孩和5名女孩）接受了以万古霉素作为初始治疗形式的一线治疗。所有培养出的细菌对万古霉素敏感。我们对这些病例进行回顾性分析，以研究类固醇剂量与抗生素治疗效果之间的关系。

结果

我们分析的10例患者中有9例接受了类固醇治疗。其中，3例接受高剂量类固醇治疗，6例接受低剂量类固醇治疗。5例患者对万古霉素无反应，包括高剂量类固醇组的所有3例患者和低剂量类固醇组的2例患者。我们的分析证实，万古霉素治疗的反应率随着类固醇剂量的增加而显著降低（P = 0.035）。在将万古霉素替换为替考拉宁后，同时接受高剂量类固醇治疗且对万古霉素无反应的患者临床症状有所改善。

结论

使用类固醇，尤其是高剂量使用，可能会削弱万古霉素治疗儿科患者细菌性脑膜炎的有效性。医生在同时给予类固醇治疗时应谨慎，并应仔细监测类固醇剂量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/d2305809226f/ic-49-262-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/bb3b75612da0/ic-49-262-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/1de1a6b1e902/ic-49-262-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/8d2b458d9465/ic-49-262-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/d2305809226f/ic-49-262-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/bb3b75612da0/ic-49-262-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/1de1a6b1e902/ic-49-262-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/8d2b458d9465/ic-49-262-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f5f/5754336/d2305809226f/ic-49-262-g004.jpg

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本文引用的文献

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Corticosteroids for acute bacterial meningitis.用于急性细菌性脑膜炎的皮质类固醇
Cochrane Database Syst Rev. 2015 Sep 12;2015(9):CD004405. doi: 10.1002/14651858.CD004405.pub5.
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Controversies in neurology, Vienna, 2012: steroids in bacterial meningitis: no.神经学争议，维也纳，2012 年：细菌性脑膜炎中的类固醇：否。
J Neural Transm (Vienna). 2013 Feb;120(2):343-6. doi: 10.1007/s00702-012-0939-z. Epub 2012 Dec 20.
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Should corticosteroids be used in bacterial meningitis in children?儿童细菌性脑膜炎是否应使用皮质类固醇？
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Adjunctive steroid treatment in acute bacterial meningitis. "To do or not to do: that is the question".急性细菌性脑膜炎的辅助性类固醇治疗。“做还是不做：这是个问题”。
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Curr Opin Neurol. 2010 Jun;23(3):312-8. doi: 10.1097/WCO.0b013e32833950dd.
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Immunological and biochemical correlates of adjunctive dexamethasone in Vietnamese adults with bacterial meningitis.越南成年细菌性脑膜炎患者辅助使用地塞米松的免疫学和生物化学相关性
Clin Infect Dis. 2009 Nov 1;49(9):1387-92. doi: 10.1086/630207.
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Increased neuronal proliferation in human bacterial meningitis.人类细菌性脑膜炎中神经元增殖增加。
Neurology. 2009 Sep 29;73(13):1026-32. doi: 10.1212/WNL.0b013e3181b9c892.
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Dexamethasone coordinately regulates angiopoietin-1 and VEGF: a mechanism of glucocorticoid-induced stabilization of blood-brain barrier.地塞米松协同调节血管生成素-1和血管内皮生长因子：糖皮质激素诱导血脑屏障稳定的一种机制。
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