细菌性脑脓肿的抗感染治疗进展

Progress on medical treatment of bacterial brain abscess

细菌性脑脓肿指细菌引起的颅内脓腔性感染,虽然发病率不高,但可导致严重后果。导致细菌性脑脓肿的病原体多为链球菌、葡萄球菌,在我国及亚洲地区,革兰阴性杆菌也是重要病原体。第3代头孢菌素联合甲硝唑是最常用的经验性用药方案,能覆盖细菌性脑脓肿的最常见病原体。细菌性脑脓肿抗感染治疗的疗程一般长于6周,且须密切监测患者临床表现和头颅影像学改变。目前多采用手术联合内科药物的治疗方案,可明显缩短疗程,预后也大大改善。单纯保守治疗在脓肿较小、病情轻等情况下可考虑,以避免手术等有创操作的风险。但总体来说,细菌性脑脓肿的药物治疗方案仍缺乏足够的循证医学证据。

Bacterial brain abscess（BBA） refers to a focal,intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus caused by bacteria.Though the incidence is rather low,BBA may lead to severe and even lethal consequences.In terms of etiology,Streptococcus and Staphylococcus are common,and Gram-negative bacilli are also implicated in China and Asia.In clinical practice,the combination of the third generation cephalosporin and metronidazole,which covers the majority of bacteria that cause BBA is the most commonly used empirical regimen.Basically,the treatment of BBA lasts more than 6 weeks,and it is strongly recommended that patients＇ clinical manifestations and brain imaging be closely monitored during the treatment.Currently,surgery combined with medication is the major therapy for BBA for a shorter duration of treatment.Conservative treatment can be adoptable under some circumstances,such as the size of abscess is small and condition of the patient is relatively good,etc.,so that risks of invasive operation could be avoided.Unfortunately,the clinical evidences support the medication treatment for BBA is still in progress.