Аннотация
Нозокомиальный менингит (НМ) является одним из грозных осложнений, возникающих у пациентов после черепно-мозговых травм и нейрохирургических вмешательств в связи с развившейся бактериемией. Распространённость НМ варьирует достаточно широко, составляя 0,8–17% от общего количества прооперированных пациентов, а его развитие сопровождается высоким риском неблагоприятного исхода. Летальность от НМ у нейрохирургических больных колеблется от 20% до 50%. Диагностика строится на клинических данных, а также результатах исследования ликвора, биохимического и микробиологического анализов. В данной статье представлены последние данные по этиологии, патогенезу, диагностике и лечению пациентов с нозокомиальным менингитом.
-
1.
Leib S.L., Boscacci R., Gratzl O., Zimmerli W. Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis 1999; 29:69-74.
-
2.
Donmez H., Mavili E., Ikizceli T., Durac A.C., Kurtsoy A. Stroke secondary to aseptic meningitis after endovascular treatment of a giant aneurysm with parent artery occlusion. Cardiovasc Intervent Radiol 2009; 32:801-3.
-
3.
Korinek A.M., Baugnon T., Golmard J.L., et al. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006; 59:126- 33.
-
4.
McClelland S., Hall W.A. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007; 45:55-9.
-
5.
Baltas I., Tsoulfa S., Sakellariou P., et al. Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome. Neurosurgery 1994; 35:422-6.
-
6.
Choi D., Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg 1996; 10:571-5.
-
7.
Baer E.T. Post-dural puncture bacterial meningitis. Anesthesiology 2006; 105:381-93.
-
8.
Weisfelt M., van de Beek D., Spanjaard L., de Gans J. Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect 2007; 66:71-8.
-
9.
Mayhall C.G., Archer N.H., Lamb V.A., et al. Ventriculostomy-related infections: a prospective epidemiologic study. N Engl J Med 1984; 310:553-9.
-
10.
Klekner A., Ga’spa’r A., Kardos S., Szabo J., Cse’csei G. Cefazolin prophylaxis in neurosurgery monitored by capillary electrophoresis. J Neurosurg Anesthesiol 2003; 15:249-54.
-
11.
Conen A., Walti L.N., Merlo A., et al. Characteristics and treatment outcome of cerebrospinal fluid shuntassociated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis 2008; 47:73-82.
-
12.
Vinchon M., Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst 2006; 22:692-7.
-
13.
Kulkarni A.V., Drake J.M., Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg 2001; 94:195-201.
-
14.
Tulipan N., Cleves M.A. Effect of an intraoperative doublegloving strategy on the incidence of cerebrospinal fluid shunt infection. J Neurosurg 2006; 104 (1 Suppl):5-8.
-
15.
Sorensen P., Ejlertsen T., Aaen D., Poulsen K. Bacterial contamination of surgeons gloves during shunt insertion: a pilot study. Br J Neurosurg 2008; 22:675-7.
-
16.
Lozier A.P., Sciacca R.R., Romagnoli M.F., Connolly E.S. Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery 2008; 62 (Suppl 2):688-700.
-
17.
Wong G.K., Poon W.S., Wai S., et al. Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomized controlled trial. J Neurol Neurosurg Psychiatry 2002; 73:759-61.
-
18.
Governale L.S., Fein N., Logsdon J., Black P.M. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery 2008; 63 (Suppl 2):379-84.
-
19.
Bullock M.R., Chesnut R., Ghajar J., et al. Surgical management of depressed cranial fractures. Neurosurgery 2006; 58 (3 Suppl):S56-60.
-
20.
Adriani K.S., van de Beek D., Brouwer M.C., Spanjaard L., de Gans J. Community-acquired recurrent bacterial meningitis in adults. Clin Infect Dis 2007; 45(5):e46-51.
-
21.
Muttaiyah S., Ritchie S., Upton A., Roberts S. Clinical parameters do not predict infection in patients with external ventricular drains: a retrospective observational study of daily cerebrospinal fluid analysis. J Med Microbiol 2008; 57:207-9.
-
22.
Schade R.P., Schinkel J., Roelandse F.W., et al. Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage-related bacterial meningitis. J Neurosurg 2006; 104:101-8.
-
23.
Beer R., Lackner P., Pfausler B., Schmutzhard E. Nosocomial ventriculitis and meningitis in neurocritical care patients. J Neurol 2008; 255:1617-24.
-
24.
Zarrouk V., Vassor I., Bert F., et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007; 44:1555-9.
-
25.
Nathan B.R., Scheld W.M. The potential roles of C-reactive protein and procalcitonin in the serum and cerebrospinal fluid in the diagnosis of bacterial meningitis. Curr Clin Top Infect Dis 2002; 22:155-65.
-
26.
Banks J.T., Bharara S., Tubbs R.S., et al. Polymerase chain reaction for the rapid detection of cerebrospinal fluid shunt or ventriculostomy infections. Neurosurgery 2005; 57:1237-43.
-
27.
Tunkel A.R., Hartman B.J., Kaplan S.L., et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267-84.
-
28.
Pfausler B., Spiss H., Beer R., et al. Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy. J Neurosurg 2003; 98:1040-4.
-
29.
Kessler A.T., Kourtis A.P. Treatment of meningitis caused by methicillin-resistant Staphylococcus aureus with linezolid. Infection 2007; 35:271-4.
-
30.
Lee D.H., Palermo B., Chowdhury M. Successful treatment of methicillin-resistant Staphylococcus aureus meningitis with daptomycin. Clin Infect Dis 2008; 47:588-90.
-
31.
Beer R., Engelhardt K.W., Pfausler B., et al. Pharmacokinetics of intravenous linezolid in cerebrospinal fluid and plasma in neurointensive care patients with staphylococcal ventriculitis associated with external ventricular drains. Antimicrob Agents Chemother 2007; 51:379-82.
-
32.
The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis. Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy Br J Neurosurg 2000; 14:7- 12.
-
33.
Wen D.Y., Bottini A.G., Hall W.A., Haines S.J. Infections in neurologic surgery. The intraventricular use of antibiotics. Neurosurg Clin N Am 1992; 3:343-54.
-
34.
Ziai W.C., Lewin J.J. III. Improving the role of intraventricular antimicrobial agents in the management of meningitis. Curr Opin Neurol 2009; 22:277-82.
-
35.
Kim B.N., Peleg A.Y., Lodise T.P., et al. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis 2009; 9:245-55.
-
36.
Falagas M.E., Bliziotis I.A., Tam V.H. Intraventricular or intrathecal use of polymyxins in patients with gramnegative meningitis: a systematic review of the available evidence. Int J Antimicrob Agents 2007; 29:9-25.
-
37.
Katragkou A., Roilides E. Successful treatment of multidrug-resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbiol 2005; 43:4916-7.
-
38.
Rodriguez Guardado A., Blanco A., Asensi V., et al. Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments. J Antimicrob Chemother 2008; 61:908-13.
-
39.
Schreffler R.T., Schreffler A.J., Wittler R.R. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J 2002; 21:632-6.
-
40.
Yogev R. Cerebrospinal fluid shunt infections: a personal view. Pediatr Infect Dis 1985; 4:113-8.
-
41.
Kestle J.R., Garton H.J., Whitehead W.E., et al. Management of shunt infections: a multicenter pilot study. J Neurosurg 2006; 105 (3 Suppl):177-81.