每日一题_2022.10.08

Which of the following patients is most likely to benefit from IV dexamethasone to reduce neurologic sequelae caused by meningitis?

A. 32-year-old man admitted to the neurosurgical ICU three weeks ago who develops a Pseudomonas-related meningitis from his ventriculoperitoneal shunt

B. 56-year-old woman admitted with presumed Streptococcus pneumoniae meningitis who has not received her first dose of antibiotics

C. 75-year-old woman admitted to theICU for herpes simplex encephalitis

D. 65-year-old man admitted for Streptococcus pneumoniae meningitis who has received appropriate antimicrobial therapy for three days

E. 38-year old paraplegic woman in the ICU being treated for an epidural abscess due to Staphylococcus aureus bacteremia

答案解析：

不利的神经系统结局不一定是抗菌药物治疗不充分的结果。脑脊液培养常在抗生素治疗开始后24～48小时无菌。在动物中的研究表明，抗生素治疗诱导的细菌溶解导致蛛网膜下腔炎症，这可能导致不利的结局。这些研究还表明，抗炎药（如地塞米松）辅助治疗可减少脑脊液炎症和神经系统后遗症，但不会降低总死亡率。地塞米松应在抗生素首次给药前或给药时给药，以达到最大获益。成人的推荐剂量为10 mg，每6小时一次，IV，持续4天。

正确答案：B