医疗保健相关脑膜炎的诊疗现状
Current Status of Diagnosis and Treatment of Healthcare-Associated Meningitis
DOI: 10.12677/acm.2024.14112971, PDF,    科研立项经费支持
作者: 方婉秋, 王振龙, 刘泉波*:重庆医科大学附属儿童医院感染科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,儿童感染与免疫罕见病重庆市重点实验室,重庆
关键词: 医疗保健相关脑室炎/脑膜炎临床特点诊断治疗Health Care-Associated Ventriculitis and Meningitis Clinical Characteristics Diagnose Treatment
摘要: 医疗保健相关脑膜炎是一种特殊的脑膜炎,其病原学谱、临床表现、治疗都有区别于社区获得性脑膜炎。它具有死亡率高、致残率高的特点,严重威胁了患者的生命。本文综述了目前医疗保健相关脑膜炎的诊疗现状,对其病原学特点、临床特点、辅助检查的选择以及治疗方式作出总结,以期帮助临床医师实现对该疾病的早识别、早治疗,改善患者结局。
Abstract: Healthcare-associated meningitis is a special type of meningitis, and whose etiological spectrum, clinical manifestations and treatment are different from community-acquired meningitis. It has the characteristics of high mortality rate and high disability rate, seriously threatening the lives of patients. This article reviews the current diagnosis and treatment status of healthcare-related meningitis, summarizes its etiological characteristics, clinical characteristics, selection of auxiliary examination and treatment methods, in order to help clinicians realize early identification and treatment of the disease and improve patients’ outcomes.
文章引用:方婉秋, 王振龙, 刘泉波. 医疗保健相关脑膜炎的诊疗现状[J]. 临床医学进展, 2024, 14(11): 971-978. https://doi.org/10.12677/acm.2024.14112971

参考文献

[1] Zeggay, A., Patry, I., Chirouze, C. and Bouiller, K. (2023) Characteristics and Outcomes of Cerebrospinal Fluid Shunt and Drain-Associated Infections. Infectious Diseases Now, 53, Article ID: 104665. [Google Scholar] [CrossRef] [PubMed]
[2] Ramanan, M., Shorr, A. and Lipman, J. (2021) Ventriculitis: Infection or Inflammation. Antibiotics, 10, Article No. 1246. [Google Scholar] [CrossRef] [PubMed]
[3] Tunkel, A.R., Hasbun, R., Bhimraj, A., Byers, K., Kaplan, S.L., Scheld, W.M., et al. (2017) 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases, 64, e34-e65. [Google Scholar] [CrossRef] [PubMed]
[4] Karvouniaris, M., Brotis, A., Tsiakos, K., Palli, E. and Koulenti, D. (2022) Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infection and Drug Resistance, 15, 697-721. [Google Scholar] [CrossRef] [PubMed]
[5] Luque-Paz, D., Revest, M., Eugène, F., Boukthir, S., Dejoies, L., Tattevin, P., et al. (2021) Ventriculitis: A Severe Complication of Central Nervous System Infections. Open Forum Infectious Diseases, 8, ofab216. [Google Scholar] [CrossRef] [PubMed]
[6] Hasbun, R. (2019) Update and Advances in Community Acquired Bacterial Meningitis. Current Opinion in Infectious Diseases, 32, 233-238. [Google Scholar] [CrossRef] [PubMed]
[7] Busl, K.M. (2019) Healthcare-Associated Infections in the Neurocritical Care Unit. Current Neurology and Neuroscience Reports, 19, Article No. 76. [Google Scholar] [CrossRef] [PubMed]
[8] Hussein, K., Bitterman, R., Shofty, B., Paul, M. and Neuberger, A. (2017) Management of Post-Neurosurgical Meningitis: Narrative Review. Clinical Microbiology and Infection, 23, 621-628. [Google Scholar] [CrossRef] [PubMed]
[9] Rogers, T., Sok, K., Erickson, T., Aguilera, E., Wootton, S.H., Murray, K.O., et al. (2019) The Comparison of Gram-Positive and Gram-Negative Healthcare-Associated Ventriculitis and Meningitis in Adults and Children. Intensive Care Medicine, 46, 128-131. [Google Scholar] [CrossRef] [PubMed]
[10] Srihawan, C., Castelblanco, R.L., Salazar, L., Wootton, S.H., Aguilera, E., Ostrosky-Zeichner, L., et al. (2016) Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients with Healthcare-Associated Ventriculitis and Meningitis. Open Forum Infectious Diseases, 3, ofw077. [Google Scholar] [CrossRef] [PubMed]
[11] Martin, R.M., Zimmermann, L.L., Huynh, M. and Polage, C.R. (2018) Diagnostic Approach to Health Care-and Device-Associated Central Nervous System Infections. Journal of Clinical Microbiology, 56, e00861-18. [Google Scholar] [CrossRef] [PubMed]
[12] Dorresteijn, K.R.I.S., Brouwer, M.C., Jellema, K. and van de Beek, D. (2020) Bacterial External Ventricular Catheter-Associated Infection. Expert Review of Anti-Infective Therapy, 18, 219-229. [Google Scholar] [CrossRef] [PubMed]
[13] Rath, P.-., Schoch, B., Adamzik, M., Steinmann, E., Buer, J. and Steinmann, J. (2014) Value of Multiplex PCR Using Cerebrospinal Fluid for the Diagnosis of Ventriculostomy-Related Meningitis in Neurosurgery Patients. Infection, 42, 621-627. [Google Scholar] [CrossRef] [PubMed]
[14] Pan, X., Zhang, Y. and Chen, G. (2023) The Clinical Utility of Metagenomic Next-Generation Sequencing for the Diagnosis of Central Nervous System Infectious Diseases. Neurological Research, 45, 919-925. [Google Scholar] [CrossRef] [PubMed]
[15] Feng, L., Chen, J., Luo, Q., Su, M., Chen, P., Lai, R., et al. (2023) mNGS Facilitates the Accurate Diagnosis and Antibiotic Treatment of Suspicious Critical CNS Infection in Real Practice: A Retrospective Study. Open Life Sciences, 18, Article ID: 20220578. [Google Scholar] [CrossRef] [PubMed]
[16] Wilson, M.R., Sample, H.A., Zorn, K.C., Arevalo, S., Yu, G., Neuhaus, J., et al. (2019) Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis. New England Journal of Medicine, 380, 2327-2340. [Google Scholar] [CrossRef] [PubMed]
[17] Wang, Q., Wang, Y., Yang, Y., Kong, Y. and Peng, Y. (2023) The Value of Elevated Cerebrospinal Fluid Lactate Concentrations in Post-Neurosurgical Bacterial Meningitis. BMC Neurology, 23, Article No. 377. [Google Scholar] [CrossRef] [PubMed]
[18] Lotfi, R., Ines, B., Aziz, D.M. and Mohamed, B. (2019) Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis. Indian Journal of Critical Care Medicine, 23, 127-130. [Google Scholar] [CrossRef] [PubMed]
[19] Baheerathan, A., Pitceathly, R.D., Curtis, C. and Davies, N.W. (2020) CSF Lactate. Practical Neurology, 20, 320-323. [Google Scholar] [CrossRef] [PubMed]
[20] Montes, K., Jenkinson, H., Habib, O.B., Esquenazi, Y. and Hasbun, R. (2019) Corrected White Blood Cell Count, Cell Index, and Validation of a Clinical Model for the Diagnosis of Health Care-Associated Ventriculitis and Meningitis in Adults with Intracranial Hemorrhage. Clinical Neurology and Neurosurgery, 178, 36-41. [Google Scholar] [CrossRef] [PubMed]
[21] Liew, S., Richards, S., Ho, K.M. and Murray, R. (2020) Utility of the Cell Index in Predicting External Ventricular Drain-Related Ventriculo-Meningitis. Neurocritical Care, 33, 776-784. [Google Scholar] [CrossRef] [PubMed]
[22] Lenski, M., Biczok, A., Neufischer, K., Tonn, J., Briegel, J. and Thon, N. (2019) Significance of Cerebrospinal Fluid Inflammatory Markers for Diagnosing External Ventricular Drain-Associated Ventriculitis in Patients with Severe Traumatic Brain Injury. Neurosurgical Focus, 47, E15. [Google Scholar] [CrossRef] [PubMed]
[23] Mink, S., List, W., Reimann, P. and Fraunberger, P. (2022) CSF-Interleukin 6 for Early Diagnosis of Ventriculitis in a Broad Intensive Care Setting. Clinical Chemistry and Laboratory Medicine (CCLM), 60, e129-e131. [Google Scholar] [CrossRef] [PubMed]
[24] Zhang, G., Yang, C., Kang, X., Gao, Z., Wan, H. and Liu, Y. (2018) The Combination of Cerebrospinal Fluid Procalcitonin, Lactate, Interleukin-8 and Interleukin-10 Concentrations for the Diagnosis of Postneurosurgical Bacterial Meningitis: A Prospective Study. Annals of Clinical Biochemistry: International Journal of Laboratory Medicine, 56, 133-140. [Google Scholar] [CrossRef] [PubMed]
[25] Zheng, G., Ji, X., Yu, X., Liu, M., Huang, J., Zhang, L., et al. (2019) Development and Verification of a Discriminate Algorithm for Diagnosing Post‐Neurosurgical Bacterial Meningitis—A Multicenter Observational Study. Journal of Clinical Laboratory Analysis, 34, e23069. [Google Scholar] [CrossRef] [PubMed]
[26] O’Horo, J.C. and Sampathkumar, P. (2017) Infections in Neurocritical Care. Neurocritical Care, 27, 458-467. [Google Scholar] [CrossRef] [PubMed]
[27] Ciummo, F., Srinivas, P. and Biedny, J. (2021) Antimicrobial Use in Central Nervous System Infections. Current Opinion in Infectious Diseases, 34, 255-263. [Google Scholar] [CrossRef] [PubMed]
[28] Lewin, J.J., Cook, A.M., Gonzales, C., Merola, D., Neyens, R., Peppard, W.J., et al. (2018) Current Practices of Intraventricular Antibiotic Therapy in the Treatment of Meningitis and Ventriculitis: Results from a Multicenter Retrospective Cohort Study. Neurocritical Care, 30, 609-616. [Google Scholar] [CrossRef] [PubMed]
[29] Zhang, Y., Zhang, J., Chen, Y., Yu, J., Cao, G., Wu, X., et al. (2017) Evaluation of Meropenem Penetration into Cerebrospinal Fluid in Patients with Meningitis after Neurosurgery. World Neurosurgery, 98, 525-531. [Google Scholar] [CrossRef] [PubMed]
[30] Pascale, R., Giannella, M., Bartoletti, M., Viale, P. and Pea, F. (2019) Use of Meropenem in Treating Carbapenem-Resistant Enterobacteriaceae Infections. Expert Review of Anti-Infective Therapy, 17, 819-827. [Google Scholar] [CrossRef] [PubMed]
[31] Liu, D., Niu, J., Chen, G. and Xu, L. (2022) Treatment of Carbapenem-Resistant Multidrug-Resistant Gram-Negative Bacilli with Intracerebroventricular Injection of Polymyxin B: A Retrospective Study. Infection and Drug Resistance, 15, 7653-7666. [Google Scholar] [CrossRef] [PubMed]
[32] Hu, Y., Li, D., Zhang, G., Dai, Y., Chen, M., Jiang, H., et al. (2024) Intraventricular or Intrathecal Polymyxin B for Treatment of Post-Neurosurgical Intracranial Infection Caused by Carbapenem-Resistant Gram-Negative Bacteria: A 8-Year Retrospective Study. European Journal of Clinical Microbiology & Infectious Diseases, 43, 875-884. [Google Scholar] [CrossRef] [PubMed]
[33] Li, M., Wu, Q., Li, J. and Chen, J. (2024) Intrathecal or Intraventricular Antimicrobial Therapy for Post-Neurosurgical Gram-Negative Bacillary Meningitis or Ventriculitis: A Systematic Review and Meta-Analysis. International Journal of Antimicrobial Agents, 63, Article ID: 107033. [Google Scholar] [CrossRef] [PubMed]
[34] Hu, Y., He, W., Yao, D. and Dai, H. (2019) Intrathecal or Intraventricular Antimicrobial Therapy for Post-Neurosurgical Intracranial Infection Due to Multidrug-Resistant and Extensively Drug-Resistant Gram-Negative Bacteria: A Systematic Review and Meta-Analysis. International Journal of Antimicrobial Agents, 54, 556-561. [Google Scholar] [CrossRef] [PubMed]
[35] Nau, R., Blei, C. and Eiffert, H. (2020) Intrathecal Antibacterial and Antifungal Therapies. Clinical Microbiology Reviews, 33, e00190-19. [Google Scholar] [CrossRef] [PubMed]
[36] Hasbun, R. (2020) Healthcare-Associated Ventriculitis: Current and Emerging Diagnostic and Treatment Strategies. Expert Review of Anti-Infective Therapy, 19, 993-999. [Google Scholar] [CrossRef] [PubMed]