Commey J O, Rodrigues O P, Akita F A, Newman M
Department of Child Health, University of Ghana Medical School, Accra.
East Afr Med J. 1994 Feb;71(2):113-7.
One hundred and three children (1% of seriously ill children referred to the Korle Bu Teaching Hospital in Accra) were admitted with bacterial meningitis over a 17 month period. 43 of these children had been ill for more than 4 days before arrival at our centre. The main causative organisms were S. pneumoniae (47.9%), Neisseria meningitides (38.4%) and Haemophilus influenzae (9.6%). All bacterial isolates were highly sensitive to ceftriaxone. Resistance to penicillin and chloramphenicol was however present in 5-17% of isolates. All cerebrospinal fluid samples were sterilised within 48 hours of antibiotic treatment. Case fatality rate was 22% with the majority of deaths occurring within hours of admission and closely related to S. pneumoniae infection. Neurological complications occurred in 22%; mild diarrhoea in 33% and secondary fever in 14.8% of survivors. No significant difference was noted among the three treatment regimens of ceftriaxone alone, penicillin plus chloramphenicol, and ceftriaxone alone for 48 hours followed by penicillin/chloramphenicol combination. Our overall outcome would have been better if patients had been started on appropriate antibiotic treatment within the earlier hours of the infection. Furthermore, the latter generation cephalosporins, including ceftriaxone, must be given consideration as antibiotics of first choice world wide.
在17个月的时间里，有103名儿童（占转诊至阿克拉科尔勒布教学医院的重症儿童的1%）因细菌性脑膜炎入院。其中43名儿童在抵达我们中心之前已患病超过4天。主要致病菌为肺炎链球菌（47.9%）、脑膜炎奈瑟菌（38.4%）和流感嗜血杆菌（9.6%）。所有细菌分离株对头孢曲松均高度敏感。然而，5%-17%的分离株对青霉素和氯霉素耐药。所有脑脊液样本在抗生素治疗48小时内均被灭菌。病死率为22%，大多数死亡发生在入院数小时内，且与肺炎链球菌感染密切相关。22%的幸存者出现神经系统并发症；33%出现轻度腹泻，14.8%出现继发发热。在单独使用头孢曲松、青霉素加氯霉素以及先单独使用头孢曲松48小时后再使用青霉素/氯霉素联合治疗这三种治疗方案之间未发现显著差异。如果患者在感染早期就开始接受适当的抗生素治疗，我们的总体治疗效果会更好。此外，包括头孢曲松在内的新一代头孢菌素必须被视为全球首选抗生素。
