Bulaeva Aleksandra, Derber Catherine
Department of Medicine, Macon & Joan Brock Virginia Health Sciences EVMS Medical Group at Old Dominion University, Norfolk, VA, USA.
Department of Medicine, Macon & Joan Brock Virginia Health Sciences EVMS Medical Group at Old Dominion University, Norfolk, VA, USA.
Med Clin North Am. 2025 May;109(3):587-599. doi: 10.1016/j.mcna.2024.12.012. Epub 2025 Feb 24.
Community-acquired bacterial meningitis has a high fatality rate, and survivors may have significant long-term neurologic sequelae, despite appropriate antibiotics. Although cerebral spinal fluid cultures and/or PCR testing are necessary to establish a definitive case of bacterial meningitis, antibiotic administration should never be delayed while waiting to obtain a lumbar puncture. Patients with suspected bacterial meningitis should be started on empiric antibiotics and adjunctive dexamethasone within an hour of presentation, with subsequent regimens targeted toward the identified pathogen. Vaccines are an important tool to minimize the risk of bacterial meningitis, and use should be encouraged by adults at higher risk.
社区获得性细菌性脑膜炎病死率高，即便使用了恰当的抗生素，幸存者仍可能有严重的长期神经后遗症。虽然脑脊液培养和/或聚合酶链反应检测对于确诊细菌性脑膜炎是必要的，但在等待进行腰椎穿刺时，抗生素治疗绝不应延迟。疑似细菌性脑膜炎的患者应在就诊后一小时内开始经验性使用抗生素和辅助性地塞米松，后续治疗方案则针对已确定的病原体。疫苗是将细菌性脑膜炎风险降至最低的重要工具，应鼓励高危成年人使用。
