Peeters A, Vandercam B, Sindic C J, Hantson P, Mahieu P
Department of Neurology, St-Luc University Hospital, Brussels, Belgium.
J Infect. 1997 Nov;35(3):303-4. doi: 10.1016/s0163-4453(97)93384-3.
Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.
粘质沙雷氏菌是成人社区获得性脑膜炎的不常见病因。我们报告一例粘质沙雷氏菌脑膜炎病例，该病例发生在头部受伤29年后，之前有3年间歇性脑脊液鼻漏。入院前1个月，患者接受了头孢羟氨苄治疗。该病例说明了脑脊液漏患者使用抗生素治疗时发生革兰氏阴性杆菌脑膜炎的风险。当患者有慢性清亮鼻漏时，在开抗生素之前应询问头部受伤病史。存在瘘管时，任何抗生素治疗都可能导致耐药菌的产生，而这些耐药菌可能难以治疗。由于脑膜炎风险高，且延迟性脑脊液鼻漏不太可能自发闭合，因此必须对任何相关瘘管进行手术修复。
