Bryan C S, Reynolds K L, Crout L
Ann Emerg Med. 1986 May;15(5):544-7. doi: 10.1016/s0196-0644(86)80990-8.
We reviewed 135 cases of acute community-acquired bacterial meningitis at a municipal teaching hospital during a six-year period, with special emphasis on promptness of initial antimicrobial therapy. Overall mortality was 5% for the 121 childhood cases, compared to 43% for the 14 adult cases (P less than .001). The mean duration between arrival in the emergency department and the administration of appropriate antibiotics was 2.1 hours for the pediatric cases, compared to 4.9 hours for the adult cases (P less than .02). Factors that may contribute to delays in institution of appropriate antimicrobial therapy for adult patients with meningitis include the relative infrequency of this condition, the presence of concomitant disease processes, and the frequent practice of obtaining a computed tomography scan prior to performing lumbar puncture. Prompt institution of antimicrobial therapy for acute meningitis, especially for adult pneumococcal meningitis, remains a major challenge for emergency physicians.
我们回顾了一家市级教学医院在六年期间的135例急性社区获得性细菌性脑膜炎病例，特别强调初始抗菌治疗的及时性。121例儿童病例的总体死亡率为5%，而14例成人病例的死亡率为43%（P小于0.001）。儿科病例从到达急诊科到给予适当抗生素的平均时间为2.1小时，而成人病例为4.9小时（P小于0.02）。可能导致成年脑膜炎患者延迟给予适当抗菌治疗的因素包括这种疾病相对少见、存在合并疾病过程以及在进行腰椎穿刺前频繁进行计算机断层扫描的做法。对急性脑膜炎，尤其是成人肺炎球菌性脑膜炎及时给予抗菌治疗，仍然是急诊医生面临的一项重大挑战。
