Madlener Marie, Joost Insa
Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Köln, Deutschland.
ABS-Team, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Inn Med (Heidelb). 2025 Feb;66(2):190-198. doi: 10.1007/s00108-025-01851-2. Epub 2025 Jan 31.
Bacterial meningitis is a rare but severe disease with a high mortality. The most frequent pathogens in adults are pneumococcus, meningococcus and Listeria. The most important key symptoms are headache, meningism and fever; however, the absence of individual cardinal symptoms does not exclude the diagnosis. The empirical treatment consists of ceftriaxone and ampicillin, supplemented with dexamethasone as needed. It should be initiated without delay if bacterial meningitis is suspected. Before this, two pairs of blood cultures should be obtained followed by a lumbar puncture. An elevated intracranial pressure must be excluded via cerebral computed tomography before performing a lumbar puncture only in patients with confirmation of impaired consciousness, focal neurological deficits or epileptic seizures. In such cases treatment is initiated immediately after obtaining blood cultures but before the lumbar puncture. The identification and management of a focus are essential and should be conducted on the day of admission.
细菌性脑膜炎是一种罕见但严重的疾病，死亡率很高。成人中最常见的病原体是肺炎球菌、脑膜炎球菌和李斯特菌。最重要的关键症状是头痛、脑膜刺激征和发热；然而，个别主要症状的缺失并不排除诊断。经验性治疗包括头孢曲松和氨苄西林，并根据需要补充地塞米松。如果怀疑是细菌性脑膜炎，应立即开始治疗。在此之前，应采集两对血培养物，然后进行腰椎穿刺。仅在意识障碍、局灶性神经功能缺损或癫痫发作得到确认的患者中，在进行腰椎穿刺前必须通过脑部计算机断层扫描排除颅内压升高。在这种情况下，在采集血培养物后但在腰椎穿刺前立即开始治疗。确定和处理感染源至关重要，应在入院当天进行。
