細菌性髄膜炎の現状

Current Clinical Management of Bacterial Meningitis

細菌性髄膜炎は，初期治療が患者の転帰に大きく影響する緊急疾患である。治療は，その地域における年齢階層別主要起炎菌の分布，耐性菌の頻度および宿主のリスクを考慮し，抗菌薬選択を行うことが必要である。2013年4月から小児におけるワクチンの定期接種化が実施され，接種率が向上し，小児のインフルエンザ菌性髄膜炎は減少してきている。これら日本の疫学的現況を把握し，現時点での診療指針として『細菌性髄膜炎診療ガイドライン2014』が公表された。その概要を中心に細菌性髄膜炎の現状について述べる。

Abstract

The recent protocols for the clinical management of bacterial meningitis (BM) is reviewed. BM can present as an acute fulminant disease that progresses rapidly in a few hours or as a subacute infection that progressively worsens during several days. The mortality rate with BM and the frequency of neurologic sequelae among those who survive are high. BM is thus a life-threatening neurological emergency. Early recognition, efficient decision-making, and the rapid institution of therapy can be lifesaving. Empirical therapy should be initiated promptly whenever BM is a significant diagnostic consideration.

The Infectious Diseases Society of America (2004) and European Federation of Neurological Societies (2008) reported an initial management approach of BM. The guidelines for the clinical management of BM in Japan were published in 2007, and the revision was published in December 2014. These initial therapeutic management protocols for BM differ for every country. The reasons for the different initial therapeutic management are based on the following strategies. The choice of the specific antimicrobial agents for the initial treatment is based on the current knowledge of the antimicrobial susceptibility patterns of these pathogens in the area. For the initial treatment, the assumption should be that antimicrobial resistance is likely. The choice of an empirical antibiotic in BM may be influenced by a number of factors, including the patient's age, systemic symptoms, and local pattern of bacterial resistance. If there is no epidemiologic evidence in Japan, a committee investigates and collects data in the revised Japanese guidelines 2014 for the clinical management of BM.