Jensen A G, Espersen F, Skinhøj P, Rosdahl V T, Frimodt-Møller N
Department of Clinical Microbiology, Bispebjerg Hospital, Copenhagen, Denmark.
Arch Intern Med. 1993 Aug 23;153(16):1902-8. doi: 10.1001/archinte.153.16.1902.
Based on a nationwide registration, the clinical and bacteriologic data from 61 postoperative and 43 hematogenous cases of Staphylococcus aureus meningitis in Denmark from 1986 through 1989 were reviewed.
Postoperative meningitis was a foreign body infection in 89% of the cases and had a lower mortality (18% [11/61]) compared with hematogenous meningitis (56% [24/43]). Hematogenous S aureus meningitis seems to be part of an overwhelming, disseminated infection as indicated by the following: 81% of the patients had bacteremia, 21% had endocarditis, and 12% had osteomyelitis. Most patients were older, often with underlying diseases, community-acquired infections, and a clinical picture of severe meningitis. The major findings were mental status changes and a high rate (34%) of focal neurological changes. The initial leukocyte count in the cerebrospinal fluid sample was low, and the bacteria were seen in Gram's stain smears in 40% of cases only. The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis. Three (12%) of 25 surviving patients had severe sequelae.
Hematogenous S aureus meningitis is a severe disease with a high mortality related to age, presence of shock, and infection with strains of phage type 95.
基于一项全国性登记，回顾了1986年至1989年丹麦61例术后金黄色葡萄球菌脑膜炎病例和43例血源性金黄色葡萄球菌脑膜炎病例的临床及细菌学数据。
术后脑膜炎在89%的病例中为异物感染，与血源性脑膜炎（56%[24/43]）相比死亡率较低（18%[11/61]）。血源性金黄色葡萄球菌脑膜炎似乎是一种严重的播散性感染的一部分，如下所示：81%的患者有菌血症，21%有感染性心内膜炎，12%有骨髓炎。大多数患者年龄较大，常有基础疾病，为社区获得性感染，临床表现为严重脑膜炎。主要表现为精神状态改变和局灶性神经改变发生率高（34%）。脑脊液样本中的初始白细胞计数较低，仅40%的病例在革兰氏染色涂片中可见细菌。预后与患者年龄和初始抗生素治疗有关。用对青霉素酶稳定的青霉素联合夫西地酸治疗的患者可能预后较好。25例存活患者中有3例（12%）有严重后遗症。
血源性金黄色葡萄球菌脑膜炎是一种严重疾病，死亡率高，与年龄、休克的存在以及95型噬菌体菌株感染有关。
