Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, Bloomsbury, London, UK.
Division of Infection and Immunity, University College London, Rayne Building, 5 University Street, London, UK.
Br Med Bull. 2019 Sep 19;131(1):57-70. doi: 10.1093/bmb/ldz023.
Acute bacterial meningitis (ABM) in adults is associated with a mortality that may exceed 30%. Immunization programs have reduced the global burden; in the UK, declining incidence but persistently high mortality and morbidity mean that clinicians must remain vigilant.
A systematic electronic literature search of PubMed was performed to identify all ABM literature published within the past 5 years.
Clinical features cannot reliably distinguish between ABM and other important infectious and non-infectious aetiologies. Prompt investigation and empirical treatment are imperative. Lumbar puncture (LP) and cerebrospinal fluid microscopy, biochemistry and culture remain the mainstay of diagnosis, but molecular techniques are increasingly useful. The 2016 UK joint specialist societies' guideline provides expert recommendations for the management of ABM, yet published data suggest clinical care delivered in the UK is frequently not adherent. Anxiety regarding risk of cerebral herniation following LP, unnecessary neuroimaging, underutilization of molecular diagnostics and suboptimal uptake of adjunctive corticosteroids compromise management.
There is increasing recognition that current antibiotic regimens and adjunctive therapies alone are insufficient to reduce the mortality and morbidity associated with ABM.
Research should be focused on optimization of vaccines (e.g. pneumococcal conjugate vaccines with extended serotype coverage), targeting groups at risk for disease and reservoirs for transmission; improving adherence to management guidelines; development of new faster, more accurate diagnostic platforms (e.g. novel point-of-care molecular diagnostics); and development of new adjunctive therapies (aimed at the host-inflammatory response and bacterial virulence factors).
成人急性细菌性脑膜炎（ABM）的死亡率可能超过 30%。免疫接种计划已经降低了全球负担；在英国，发病率虽然下降，但死亡率和发病率仍然很高，这意味着临床医生必须保持警惕。
通过系统的电子文献检索 PubMed，确定了过去 5 年内发表的所有 ABM 文献。
临床特征无法可靠地区分 ABM 和其他重要的感染性和非感染性病因。及时的调查和经验性治疗至关重要。腰椎穿刺（LP）和脑脊液显微镜检查、生物化学和培养仍然是诊断的主要方法，但分子技术越来越有用。2016 年英国联合专业协会指南为 ABM 的管理提供了专家建议，但发表的数据表明，英国提供的临床护理经常不符合规范。由于担心 LP 后出现脑疝的风险、不必要的神经影像学检查、分子诊断的利用率低以及辅助皮质类固醇的应用不足，导致管理受到影响。
越来越多的人认识到，仅依靠目前的抗生素方案和辅助治疗不足以降低与 ABM 相关的死亡率和发病率。
研究应集中于优化疫苗（例如，具有扩展血清型覆盖范围的肺炎球菌结合疫苗），针对疾病风险人群和传播源；提高对管理指南的依从性；开发新的更快、更准确的诊断平台（例如新型即时分子诊断）；并开发新的辅助治疗方法（针对宿主炎症反应和细菌毒力因子）。
