Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter^[*]

Zusammenfassung

Das Hauptziel dieses Manuskripts war ein Upgrading der DGN-Leitlinie „Ambulant erworbene bakterielle (eitrige) Meningoenzephalitis im Erwachsenenalter“ auf ein S2k-Niveau nach den Standards der AWMF. Zehn nominierte Mitglieder der Deutschen Gesellschaft für Neurologie (DGN), Schweizerischen Neurologischen Gesellschaft (SNG), Österreichischen Gesellschaft für Neurologie (ÖGN), Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM), Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG), Deutschen Gesellschaft für Neuroradiologie (DGNR), Deutschen Gesellschaft für Neurointensiv- und Notfallmedizin (DGNI), Deutschen Gesellschaft für Infektiologie (DGI), Deutschen Gesellschaft für Innere Medizin (DGIM) und der Deutschen Gesellschaft für Liquordiagnostik und Klinische Neurochemie (DGLN) waren an der Formulierung dieser Leitlinie beteiligt. Die Vorstände der Fachgesellschaften stimmten der Leitlinie zu. Die Leitlinie gibt einen Überblick über die klinischen Manifestationen und Komplikationen der bakteriellen Meningoenzephalitis im Erwachsenenalter, den notwendigen diagnostischen Schritten, den Therapieempfehlungen und den wichtigsten Präventionsmaßnahmen.

Abstract

The major purpose of this manuscript was to provide an upgrading of the guideline “Community-acquired bacterial (purulent) meningoencephalitis in adults” to an S2k-level according to the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften e. V, AWMF) standards. Ten nominated members of the German Neurological Society (DGN), Swiss Neurological Society (SNG), Austrian Society of Neurology (ÖGN), German Society for Hygiene and Microbiology (DGHM), Paul-Ehrlich-Gesellschaft for Chemotherapy (PEG), German Society of Neuroradiology, German Society for NeuroIntensive- and Emergency Medicine (DGNI), German Society for Infectiology (DGI), German Society for Internal Medicine (DGIM) and German Society for CSF Diagnosis and Clinical Neurochemistry (DGLN) were involved. The executive committees of these societies approved the guideline. These guideline recommendations give an overview of the clinical manifestations and complications of bacterial meningoencephalitis in adults, the diagnostic approach, the management and major prevention strategies.

Schlüsselwörter

Leitlinie - bakterielle Meningoenzephalitis - bakterielle Meningitis - Pneumokokken - Meningokokken - Listeria monoycytogenes

Keywords

guideline - bacterial meningoencephalitis - bacterial meningitis - pneumococci - meningococci - listeria monoycytogenes

^* Den Leitlinientext zusammen mit der Interessenkonflikterklärung finden Sie auch auf www-dgn.org/leitlinien sowie www.awmf.de.

• Literatur

• 1 Brouwer MC, McIntyre P, Prasad K et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015; CD004405
• 2 Glimaker M, Johansson B, Halldorsdottir H et al. Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study. PLoS One 2014; 9: e91976
• 3 Mourvillier B, Tubach F, van de Beek D et al. Induced hypothermia in severe bacterial meningitis: a randomized clinical trial. JAMA 2013; 310: 2174-2183
• 4 Ajdukiewicz KM, Cartwright KE, Scarborough M et al. Glycerol adjuvant therapy in adults with bacterial meningitis in a high HIV seroprevalence setting in Malawi: a double-blind, randomised controlled trial. Lancet Infect Dis 2011; 11: 293-300
• 5 Domingo P, Pomar V, de Benito N et al. The spectrum of acute bacterial meningitis in elderly patients. BMC Infect Dis 2013; 13: 108
• 6 Cabellos C, Viladrich PF, Ariza J et al. Community-acquired bacterial meningitis in cirrhotic patients. Clin Microbiol Infect 2008; 14: 35-40
• 7 Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 2003; 126: 1015-1025
• 8 Heckenberg SG, de Gans J, Brouwer MC et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008; 87: 185-192
• 9 Hegen H, Auer M, Deisenhammer F. Serum glucose adjusted cut-off values for normal cerebrospinal fluid/serum glucose ratio: implications for clinical practice. Clin Chem Lab Med 2014; 52: 1335-1340
• 10 Leen WG, Willemsen MA, Wevers RA et al. Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. PLoS One 2012; 7: e42745
• 11 Dubos F, Korczowski B, Aygun DA et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med 2008; 162: 1157-1163
• 12 Krysan D. Serum procalcitonin levels aid in distinguishing bacterial from aseptic meningitis in children. J Pediatr 2009; 154: 773
• 13 Prasad R, Kapoor R, Mishra OP et al. Serum procalcitonin in septic meningitis. Indian J Pediatr 2013; 80: 365-370
• 14 Viallon A, Desseigne N, Marjollet O et al. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. Crit Care 2011; 15: R136
• 15 Klein M, Pfister HW. [Bacterial infections of the central nervous system]. Nervenarzt 2010; 81: 150-161
• 16 Konstantinidis T, Cassimos D, Gioka T et al. Can Procalcitonin in Cerebrospinal Fluid be a Diagnostic Tool for Meningitis?. J Clin Lab Anal 2015; 29: 169-174
• 17 Li Y, Zhang G, Ma R et al. The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis. Clin Biochem 2015; 48: 50-54
• 18 Brouwer MC, Thwaites GE, Tunkel AR et al. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet 2012; 380: 1684-1692
• 19 Kniehl E, Doerries R, Geiß HK. Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik: MiQ; 17. Urban und Fischer; 2001
• 20 Saha SK, Darmstadt GL, Baqui AH et al. Identification of serotype in culture negative pneumococcal meningitis using sequential multiplex PCR: implication for surveillance and vaccine design. PLoS One 2008; 3: e3576
• 21 Lummel N, Koch M, Klein M et al. Spectrum and Prevalence of Pathological Intracranial Magnetic Resonance Imaging Findings in Acute Bacterial Meningitis. Clin Neuroradiol 2014;
• 22 Pfister HW, Feiden W, Einhaupl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 1993; 50: 575-581
• 23 Kasanmoentalib ES, Brouwer MC, van der Ende A et al. Hydrocephalus in adults with community-acquired bacterial meningitis. Neurology 2010; 75: 918-923
• 24 Bodilsen J, Dalager-Pedersen M, Schonheyder HC et al. Stroke in community-acquired bacterial meningitis: a Danish population-based study. Int J Infect Dis 2014; 20: 18-22
• 25 Klein M, Koedel U, Pfefferkorn T et al. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care 2011; 15: R281
• 26 Schut ES, Brouwer MC, de Gans J et al. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. Neurology 2009; 73: 1988-1995
• 27 Lucas MJ, Brouwer MC, van de Beek D. Delayed cerebral thrombosis in bacterial meningitis: a prospective cohort study. Intensive Care Med 2013; 39: 866-871
• 28 Klein M, Koedel U, Kastenbauer S et al. Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis: past as prologue: delayed stroke as a parainfectious process of bacterial meningitis?. Neurology 2010; 75: 193, author reply 193 – 194
• 29 Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 1993; 12: 389-394
• 30 Murthy JM, Prabhakar S. Bacterial meningitis and epilepsy. Epilepsia 2008; 49 (Suppl. 06) 8-12
• 31 Hasbun R, Abrahams J, Jekel J et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001; 345: 1727-1733
• 32 Nationales Referenzzentrum für Meningokokken und Haemophilus influenzae (NRZMHi). Daten zur Laborüberwachung von Meningokokken 2014. In: Daten zur Laborüberwachung von Meningokokken: Robert Koch-Institut; 2014. http://www.meningococcus.uni-wuerzburg.de/startseite/berichte/berichte_meningokokken/daten_2014/
• 33 Gilsdorf A. Meningokokken, invasive Erkrankung. In: Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2013. Robert Koch-Institut; 2014: 154-156
• 34 Lam TT, Claus H, Elias J et al. Ampicillin resistance of invasive Haemophilus influenzae isolates in Germany 2009 – 2012. Int J Med Microbiol 2015; 305: 748-755
• 35 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: 1040-1044
• 36 Rupprecht TA, Pfister HW. Clinical experience with linezolid for the treatment of central nervous system infections. Eur J Neurol 2005; 12: 536-542
• 37 Ntziora F, Falagas ME. Linezolid for the treatment of patients with central nervous system infection. Ann Pharmacother 2007; 41: 296-308
• 38 Beer R, Engelhardt KW, 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: 379-382
• 39 Paris MM, Hickey SM, Uscher MI et al. Effect of dexamethasone on therapy of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis. Antimicrob Agents Chemother 1994; 38: 1320-1324
• 40 Pfausler B, Spiss H, Dittrich P et al. Concentrations of fosfomycin in the cerebrospinal fluid of neurointensive care patients with ventriculostomy-associated ventriculitis. J Antimicrob Chemother 2004; 53: 848-852
• 41 Glimaker M, Johansson B, Grindborg O et al. Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture. Clin Infect Dis 2015; 60: 1162-1169
• 42 Proulx N, Frechette D, Toye B et al. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM 2005; 98: 291-298
• 43 Koster-Rasmussen R, Korshin A, Meyer CN. Antibiotic treatment delay and outcome in acute bacterial meningitis. J Infect 2008; 57: 449-454
• 44 Auburtin M, Wolff M, Charpentier J et al. Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med 2006; 34: 2758-2765
• 45 Roos KL, Tunkel A, van de Beek D et al. Acute bacterial Meningitis. In: Scheld M, Whitley R, Marra C, eds. Infections of the Central Nervous System. Philadelphia: Wolters Kluwer Health; 2014: 365-419
• 46 Nau R. Osmotherapy for elevated intracranial pressure: a critical reappraisal. Clin Pharmacokinet 2000; 38: 23-40
• 47 Baussart B, Cheisson G, Compain M et al. Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure. Acta Anaesthesiol Scand 2006; 50: 762-765
• 48 Perin A, Nascimben E, Longatti P. Decompressive craniectomy in a case of intractable intracranial hypertension due to pneumococcal meningitis. Acta Neurochir (Wien) 2008; 150: 837-842; discussion 842
• 49 Bordes J, Boret H, Lacroix G et al. Decompressive craniectomy guided by cerebral microdialysis and brain tissue oxygenation in a patient with meningitis. Acta Anaesthesiol Scand 2011; 55: 130-133
• 50 Southwick FS. Septic thrombophlebitis of major dural venous sinuses. Curr Clin Top Infect Dis 1995; 15: 179-203
• 51 de Gans J, van de Beek D. European Dexamethasone in Adulthood Bacterial Meningitis Study I. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347: 1549-1556
• 52 Brouwer MC, McIntyre P, de Gans J et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010; CD004405
• 53 Brouwer MC, McIntyre P, Prasad K et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2013; CD004405
• 54 Heckenberg SG, Brouwer MC, van der Ende A et al. Adjunctive dexamethasone in adults with meningococcal meningitis. Neurology 2012; 79: 1563-1569
• 55 Robert Koch-Institut. Meningokokken-Erkrankungen. In: RKI-Ratgeber für Ärzte – Infektionsschutz. Robert Koch-Institut; 2010
• 56 Robert Koch-Institut. Empfehlungen der ständigen Impfkomission (STIKO) am Robert Koch-Institut/Stand August 2015. In: Robert Koch-Institut, ed. Epidemiologisches Bulletin 37. 2015: 394-410
• 57 Rendi-Wagner P, Klein JP. Impfplan Österreich 2015. Bundesministerium für Gesundheit (BMG); 2015
• 58 Robert Koch-Institut. Aktuelle Statistik meldepflichtiger Infektionskrankheiten, Deutschland. In: Robert Koch-Institut, ed. Epidemiologisches Bulletin 3. 2015: 23
• 59 Steindl G, Kornschober C, Schmid D. Nationale Referenzzentrale für Meningokokken, Jahresbericht 2014. Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES); 2015
• 60 Hinrikson H, Emonet S, Schrenzel J. 2014 Annual Report. Swiss National Reference Center for Meningococci; 2015