2016+ESCMID指南：急性细菌性脑膜炎的诊断和治疗

ORIGINALARTICLEESCMIDguideline:diagnosisandtreatmentofacutebacterialmeningitisD.vandeBeek1,C.Cabellos2,O.Dzupova3,S.Esposito4,M.Klein5,A.T.Kloek1,S.Leib6,B.Mourvillier7,C.Ostergaard8,P.Pagliano9,H.W.Pfister5,R.C.Read10,O.ResatSipahi11andM.C.Brouwer1,fortheESCMIDStudyGroupforInfectionsoftheBrain(ESGIB)1)DepartmentofNeurology,AcademicMedicalCenter,Amsterdam,TheNetherlands,2)DepartmentofInfectiousDiseases,HospitalUniversitarideBellvitge,Barcelona,Spain,3)DepartmentofInfectiousDiseases,CharlesUniversity,ThirdFacultyofMedicine,Prague,CzechRepublic,4)PediatricHighlyIntensiveCareUnit,FondazioneIRCCSCa’GrandaOspedaleMaggiorePoliclinico,UniversitàdegliStudidiMilano,Milan,Italy,5)DepartmentofNeurology,KlinikumGroßhadern,Munich,Germany,6)DepartmentofInfectiousDiseases,InstituteforInfectiousDiseases,Bern,Switzerland,7)DepartmentofIntensiveCareMedicine,GroupeHospitalierBichat-ClaudeBernard,Paris,France,8)DepartmentofClinicalMicrobiology,CopenhagenUniversityHospitalHvidovre,Hvidovre,Denmark,9)DepartmentofInfectiousDiseases,“D.Cotugno”Hospital,Naples,Italy,10)DepartmentofInfectiousDiseases,SouthamptonGeneralHospital,Southampton,UnitedKingdomand11)DepartmentofInfectiousDiseasesandClinicalMicrobiology,EgeUniversity,Izmir,TurkeyKeywords:Antibiotic,bacterialmeningitis,ESCMID,guideline,Neisseriameningtidis,StreptococcuspneumoniaeOriginalSubmission:10December2015;Accepted:11January2016Editor:D.RaoultArticlepublishedonline:XXXCorrespondingauthor:M.C.Brouwer,DepartmentofNeurology,AcademicMedicalCenter,Meibergdreef9,1105AZAmsterdam,TheNetherlandsE-mail:[e-mail]ivationforguidelinedevelopmentBacterialmeningitisisasevereinfectiousdiseaseofthemem-branesliningthebrainresultinginahighmortalityandmorbiditythroughouttheworld.Inthepastdecadestheepidemiologyandtreatmentstrategiesforcommunity-acquiredbacterialmeningitishavesignificantlychanged[1–3].First,theintroductionofcon-jugatevaccinesinEuroperesultedinthevirtualdisappearanceofHaemophilusinfluenzaetypeb,whileconjugatepneumococcalandmeningococcalvaccineshavesubstantiallyreducedtheburdenofbacterialmeningitis[1].Asaresult,community-acquiredbacterialmeningitishasbecomeadiseasethatcurrentlyaffectsmoreadultsthaninfants,withitsspecificcomplicationsandtreatmentoptions.AsecondimportantdevelopmentistheincreasingrateofreducedsusceptibilitytocommonantimicrobialagentsamongstrainsofStreptococcuspneumoniae(pneumococcus)andNeisseriameningi-tidis(meningococcus).LargedifferencesinresistanceratesinEuropeexist,andempiricantibiotictreatmentneedstobeadjustedaccordingtoregionalepidemiology.Finally,severaladjunctivetreatmentshavebeentestedinrandomizedcontrolledtrials,oftenwithconflictingresults[3].Thesedevelopmentsleavethephysicianinneedofaclearpracticalguideline,summarizingtheavailableevidencefordiagnosticmethods,andantimicrobialandadjunctivetreatmentinbacterialmeningitis.TothisendtheEuropeanSocietyforClinicalMicrobiologyandInfectiousDis-eases(ESCMID)promotesguidelinesdevelopmentinthefieldofinfectiousdiseases.ThisguidelineprojectwasinitiatedbytheESCMIDStudyGroupforInfectionsoftheBrain(ESGIB).AimofguidelineTheguidelineisaimedatprovidingguidanceindailypracticefordiagnosisandtreatmentofcommunity-acquiredbacterialmeningitisinhospitals.Theconclusionsoftheguidelineprovideup-to-datescientificevidenceforbestmedicalpractice.Therecommendationsareaimedatexplicatingthisbestmedicalpracticeandarebasedonavailablescientificevidenceandtheconsiderationsoftheguidelinecommittee.Thecommitteeformulatedtenkeyquestionsandseveralsubquestions,whichaimtoaddressthefullspectrumofcurrentclinicaldilemmasinthediagnosisandtreatmentofcommunity-acquiredbacterialmeningitis.Epidemiology.1.Whatarethecausativemicroorganismsofcommunity-acquiredbacterialmeningitisinspecificgroups(neonates,children,adultsandimmunocompromisedpatients)?Diagnosis.2.Whataretheclinicalcharacteristicsofcommunity-acquiredbacterialmeningitis,andwhatistheirdiagnosticaccuracy?ClinMicrobiolInfect2016;-:1.e1–1.e26ClinicalMicrobiologyandInfection©2016EuropeanSocietyofClinicalMicrobiologyandInfectiousDiseases.PublishedbyElsevierLtd.Allrightsreservedfiedorinculture-negativepatients?5.1.Doestheadditionofvancomycinorrifampicintoathird-generationcephalosporinimprovesoutcomeinpneumococcalmeningitispatientsinthesettingofahigh-resistance-rateofpneumococci?6.Doesdexamethasonehaveabeneficialeffectondeath,functionaloutcomeandhearinglossinadultsandchildrenwithbacterialmeningitis?6.1.Uptowhatpointintimeistreatmentwithdexamethasoneindicatedifantibioticsarealreadyprovided?6.2.Shoulddexamethasonebestoppedifpathogen