Feldman W E
J Pediatr. 1976 Apr;88(4 Pt 1):549-52. doi: 10.1016/s0022-3476(76)80003-0.
Concentrations of bacteria in cerebrospinal fluid ranged from 4.5 X 10(3) to 3 X 10(8) colony-forming units/ml in 27 patients with bacterial meningitis before antibiotic therapy and from 4 X 10(1) to 1.4 X 10(6) CFU/ml in four patients after one to two days of antibiotic therapy. All patients with persistent positive cultures had pretreatment concentrations of 10(7) CFU/ml or greater. A significant association was observed between cerebrospinal fluid lactic acid dehydrogenase activity and concentrations of bacteria (p less than 0.01). Large inocula of Hemophilus influenzae type b (10(7)) increased the minimal inhibitory concentration for penicillin and ampicillin but not for chloramphenicol. The minimal inhibitory concentration of each of the three antibiotics increased when group B streptococci were assayed. These data indicate that persistence of a positive culture may be related to large initial concentrations of bacteria. The relative "resistance" in vitro of large inocula possibly contributes to this persistence. These observations are also consistent with the hypothesis that lactic acid dehydrogenase activity in cerebrospinal fluid is derived from bacteria.
27例细菌性脑膜炎患者在抗生素治疗前脑脊液中的细菌浓度为4.5×10³至3×10⁸菌落形成单位/毫升，4例患者在抗生素治疗1至2天后的细菌浓度为4×10¹至1.4×10⁶CFU/毫升。所有培养持续阳性的患者治疗前浓度为10⁷CFU/毫升或更高。观察到脑脊液乳酸脱氢酶活性与细菌浓度之间存在显著关联（p<0.01）。b型流感嗜血杆菌的大量接种物（10⁷）增加了青霉素和氨苄西林的最低抑菌浓度，但未增加氯霉素的最低抑菌浓度。检测B组链球菌时，三种抗生素的最低抑菌浓度均升高。这些数据表明培养阳性的持续存在可能与细菌的初始高浓度有关。大量接种物在体外的相对“耐药性”可能导致了这种持续存在。这些观察结果也与脑脊液中乳酸脱氢酶活性来源于细菌的假设一致。
