社区获得性细菌性脑膜炎的致病菌及抗菌药物治疗进展

发布时间：2018-08-25 14:22

【摘要】：目的:了解社区获得性细菌性脑膜炎的致病菌和抗菌药物治疗的研究进展。方法:查阅近年来国内外相关文献,就社区获得性细菌性脑膜炎的致病菌和抗菌药物治疗的研究进行归纳和总结,以期为社区获得性细菌性脑膜炎的临床治疗提供参考。结果与结论:社区获得性细菌性脑膜炎的致病菌分布具有年龄差异。新生儿细菌性脑膜炎最常见的病原菌为无乳链球菌和大肠埃希菌;儿童为脑膜炎双球菌和肺炎链球菌;成人为肺炎链球菌和脑膜炎双球菌;免疫力低下患者为肺炎链球菌;另一个重要的致病菌为单核细胞增多性李斯特菌。社区获得性细菌性脑膜炎的经验性治疗方案中的抗菌药物选择取决于患者年龄和细菌耐药性。社区获得性细菌性脑膜炎的目标治疗要依据细菌培养和药敏结果选择抗菌药物。对头孢菌素耐药(MIC≥2μg/m L)的肺炎链球菌首选万古霉素联合利福平,或万古霉素联合头孢噻肟/头孢曲松,或利福平联合头孢噻肟/头孢曲松,疗程为10~14 d;对青霉素耐药(MIC≥0.1μg/m L)的脑膜炎双球菌首选头孢噻肟/头孢曲松,疗程为7 d;单核细胞增多性李斯特菌脑膜炎的治疗首选阿莫西林、氨苄西林或青霉素G,疗程为≥21 d;对甲氧西林耐药的金黄色葡萄球菌首选万古霉素,若对万古霉素耐药(MIC2μg/m L)首选利奈唑胺,疗程为≥14 d;细菌培养阴性患者,经验性抗菌治疗至少2周。因此,临床治疗社区获得性细菌性脑膜炎时,应依据细菌培养和药敏结果尽可能明确病原菌种类,抗菌药物的使用原则主要包括准确、早期和足量。
[Abstract]:Objective: to investigate the progress of community-acquired bacterial meningitis and antimicrobial therapy. Methods: to review the relevant literatures at home and abroad in recent years, sum up and summarize the research on the pathogenic bacteria and antimicrobial agents of community-acquired bacterial meningitis, in order to provide reference for the clinical treatment of community-acquired bacterial meningitis. Results and conclusion: the distribution of pathogenic bacteria in community acquired bacterial meningitis was different in age. The most common pathogens of neonatal bacterial meningitis were streptococcus lactobacillus and Escherichia coli; children were meningococci and pneumococcus; adults were Streptococcus pneumoniae and meningococci; patients with low immunity were Streptococcus pneumoniae; Another important pathogen is Listeria monocytogenes. The choice of antibiotics in the experiential treatment of community-acquired bacterial meningitis depends on the patient's age and bacterial resistance. The target therapy of community acquired bacterial meningitis should be based on the results of bacterial culture and drug sensitivity. Vancomycin combined with rifampicin, vancomycin combined with cefotaxime / ceftriaxone or rifampicin combined with cefotaxime / ceftriaxone were the first choice for Streptococcus pneumoniae resistant to cephalosporin (MIC 鈮，

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