【摘要】：目的:了解社區(qū)獲得性細(xì)菌性腦膜炎的致病菌和抗菌藥物治療的研究進(jìn)展。方法:查閱近年來國(guó)內(nèi)外相關(guān)文獻(xiàn),就社區(qū)獲得性細(xì)菌性腦膜炎的致病菌和抗菌藥物治療的研究進(jìn)行歸納和總結(jié),以期為社區(qū)獲得性細(xì)菌性腦膜炎的臨床治療提供參考。結(jié)果與結(jié)論:社區(qū)獲得性細(xì)菌性腦膜炎的致病菌分布具有年齡差異。新生兒細(xì)菌性腦膜炎最常見的病原菌為無乳鏈球菌和大腸埃希菌;兒童為腦膜炎雙球菌和肺炎鏈球菌;成人為肺炎鏈球菌和腦膜炎雙球菌;免疫力低下患者為肺炎鏈球菌;另一個(gè)重要的致病菌為單核細(xì)胞增多性李斯特菌。社區(qū)獲得性細(xì)菌性腦膜炎的經(jīng)驗(yàn)性治療方案中的抗菌藥物選擇取決于患者年齡和細(xì)菌耐藥性。社區(qū)獲得性細(xì)菌性腦膜炎的目標(biāo)治療要依據(jù)細(xì)菌培養(yǎng)和藥敏結(jié)果選擇抗菌藥物。對(duì)頭孢菌素耐藥(MIC≥2μg/m L)的肺炎鏈球菌首選萬(wàn)古霉素聯(lián)合利福平,或萬(wàn)古霉素聯(lián)合頭孢噻肟/頭孢曲松,或利福平聯(lián)合頭孢噻肟/頭孢曲松,療程為10~14 d;對(duì)青霉素耐藥(MIC≥0.1μg/m L)的腦膜炎雙球菌首選頭孢噻肟/頭孢曲松,療程為7 d;單核細(xì)胞增多性李斯特菌腦膜炎的治療首選阿莫西林、氨芐西林或青霉素G,療程為≥21 d;對(duì)甲氧西林耐藥的金黃色葡萄球菌首選萬(wàn)古霉素,若對(duì)萬(wàn)古霉素耐藥(MIC2μg/m L)首選利奈唑胺,療程為≥14 d;細(xì)菌培養(yǎng)陰性患者,經(jīng)驗(yàn)性抗菌治療至少2周。因此,臨床治療社區(qū)獲得性細(xì)菌性腦膜炎時(shí),應(yīng)依據(jù)細(xì)菌培養(yǎng)和藥敏結(jié)果盡可能明確病原菌種類,抗菌藥物的使用原則主要包括準(zhǔn)確、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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