[社区获得性细菌性脑膜脑炎:新指南]。

Deutsche medizinische Wochenschrift (1946) Pub Date : 2024-08-01 Epub Date: 2024-08-15 DOI:10.1055/a-2204-5167
Alexandros Hadjilaou, Manuel Alexander Friese
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引用次数: 0

摘要

更新针对脑膜炎球菌和肺炎球菌的疫苗接种建议,特别是自 2024 年 1 月起将 B 型疫苗作为婴儿的标准接种疫苗,并调整婴儿和 60 岁及以上成人的肺炎球菌疫苗接种策略,接种最新的结合疫苗(PCV13、PCV15 和 PCV20)。强调需要进行快速诊断性腰椎穿刺并同时进行血清和脑脊液分析,以提高诊断精确度。引入血清中的降钙素原(PCT)作为区分细菌性和病毒性脑膜炎的额外生物标志物。使用多重 PCR 作为标准诊断的补充,而不是替代,以加快病原体的鉴定。根据当前的耐药性情况调整抗生素建议,特别是对于脑膜炎球菌性脑膜炎,只有在耐药性检测后才考虑使用青霉素 G。澄清地塞米松在细菌性脑膜炎中的使用范围和持续时间,尤其是在肺炎球菌脑膜炎中的使用范围和持续时间,以及李斯特菌脑膜炎中存在争议的数据情况。
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[Community-Acquired Bacterial Meningoencephalitis: The New Guideline].

Updating the vaccination recommendations against meningococci and pneumococci, in particular the introduction of the B vaccine as the standard vaccination for infants from January 2024 and the adaptation of the pneumococcal vaccination strategy for infants and adults aged 60 and over with the latest conjugate vaccines (PCV13, PCV15, PCV20).Emphasis on the need for rapid diagnostic lumbar puncture and simultaneous serum and cerebrospinal fluid analysis to increase diagnostic precision. The introduction of procalcitonin (PCT) in serum as an additional biomarker to differentiate between bacterial and viral meningitis.The use of multiplex PCR as a supplement, not a replacement, for standard diagnostics to speed up pathogen identification.Adaptation of antibiotic recommendations based on the current resistance situation, in particular for meningococcal meningitis, consideration of penicillin G only after resistance testing.Clarification of the areas and duration of use of dexamethasone in bacterial meningitis, particularly in pneumococcal meningitis and the controversial data situation in Listeria meningitis.New findings on the safe use of heparin in septic sinus thrombosis without increased risk of hemorrhage.

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