de Louvois J, Gortavai P, Hurley R
Br Med J. 1977 Oct 15;2(6093):981-4. doi: 10.1136/bmj.2.6093.981.
Pus from 46 patients with abscesses of the central nervous system (CNS) was examined for bacteria; bacteria were found in all patients. Streptococci were isolated from 36 patients and most isolates were Streptococcus milleri, Lancefield Group F, Ottens and Winkler type O III. Staphylococci were isolated from nine patients, organisms of the bacteroides group from 11, Proteus spp from seven, Klebsiella aerogenes from one, and Haemophilus aphrophilus from one. Pure cultures predominated over mixed cultures. Streptococci were isolated from abscesses of all types, and at all sites, but members of the Enterobacteriaceae and of the bacteroides group were isolated, in mixed cultures, principally from abscesses of the temporal lobe secondary to infection of the middle ear. Staphylococci predominated in abscesses that followed accidental or surgical trauma. Compared with fully sensitive control organisms, microbes infecting half the patients were resistant to penicillin. The prognosis of abscess of the CNS is grave, and the microbiological findings have important consequences for treatment. Prompt inoculation of specimens to culture plates and prompt incubation are mandatory if bacteria are to be cultured. Inhibitors of antimicrobial agents should be added to culture media if antibiotics have been administered. Provided that the site of the abscess and the antecedent history are ascertainable, the neurosurgeon should be able to start appropriate treatment while awaiting the results of culture.
对46例中枢神经系统（CNS）脓肿患者的脓液进行了细菌检查；所有患者均发现有细菌。从36例患者中分离出链球菌，大多数分离株为米勒链球菌，兰斯菲尔德F组，奥滕斯和温克勒O III型。从9例患者中分离出葡萄球菌，从11例中分离出拟杆菌属细菌，从7例中分离出变形杆菌属，从1例中分离出产气克雷伯菌，从1例中分离出血嗜沫菌。纯培养物多于混合培养物。链球菌可从所有类型和所有部位的脓肿中分离出来，但肠杆菌科和拟杆菌属细菌主要是在混合培养物中从继发于中耳感染的颞叶脓肿中分离出来的。葡萄球菌在意外或手术创伤后形成的脓肿中占主导地位。与完全敏感的对照微生物相比，感染半数患者的微生物对青霉素耐药。中枢神经系统脓肿的预后严重，微生物学检查结果对治疗有重要影响。如果要培养细菌，必须将标本迅速接种到培养平板上并迅速孵育。如果已经使用了抗生素，应在培养基中添加抗菌剂抑制剂。只要脓肿部位和既往病史可确定，神经外科医生应能够在等待培养结果的同时开始适当的治疗。
