Wanyoike M N, Waiyaki P G, McLiegeyo S O, Wafula E M
Nairobi Heart Clinic, Kenya.
East Afr Med J. 1995 Oct;72(10):658-60.
A descriptive cross sectional study on bacteriology and sensitivity patterns of laboratory-proven pyogenic meningitis was carried out over a six month period. A total of 92 patients (52 adults, 40 children) were studied. In 75 (82%) of the cases, the cerebrospinal fluid cultures were bacteriologically positive. Common isolates included Streptococcus pneumoniae (45%), Neisseria meningitidis (14%) and Haemophilus influenzae (12%). Other isolates included Cryptococcus neoformans from four (4.3%) adults who were also HIV-l positive. Sensitivity to antibiotics was determined using the disk diffusion method. There was no resistance to chloramphenicol among the three most common bacterial isolates. However, 7% and 15% of Streptococcus pneumoniae and N. meningitidis isolates, respectively, were resistant to crystalline penicillin. Twenty seven percent of Haemophilus influenzae was resistant to ampicillin. Sensitivity of the three organisms to the third generation cephalosporin (ceftazidime, cefotaxime, ceftriaxone) a second generation cephalosporin (cefuroxime) and augmentin was almost 100%. We recommend that chloramphenicol and crystalline penicillin or ampicillin be initial blind therapy for adults and older children with pyogenic meningitis and ampicillin and chloramphenicol for pre-school children. The above cephalosporins and augmentin are alternative therapy but their use will be limited by cost.
在六个月的时间里，开展了一项关于实验室确诊的化脓性脑膜炎细菌学及药敏模式的描述性横断面研究。共研究了92例患者（52例成人，40例儿童）。75例（82%）病例的脑脊液培养细菌学呈阳性。常见分离菌包括肺炎链球菌（45%）、脑膜炎奈瑟菌（14%）和流感嗜血杆菌（12%）。其他分离菌包括4例（4.3%）成人的新型隐球菌，这些成人HIV - 1也呈阳性。采用纸片扩散法测定对抗生素的敏感性。三种最常见的细菌分离菌对氯霉素均无耐药性。然而，肺炎链球菌和脑膜炎奈瑟菌分离株分别有7%和15%对结晶青霉素耐药。27%的流感嗜血杆菌对氨苄西林耐药。这三种微生物对第三代头孢菌素（头孢他啶、头孢噻肟、头孢曲松）、第二代头孢菌素（头孢呋辛）和阿莫西林/克拉维酸的敏感性几乎为100%。我们建议，对于成人和大龄儿童化脓性脑膜炎，氯霉素和结晶青霉素或氨苄西林为初始经验性治疗药物；对于学龄前儿童，氨苄西林和氯霉素为初始经验性治疗药物。上述头孢菌素和阿莫西林/克拉维酸为替代治疗药物，但它们的使用会受到成本的限制。
