细菌性脑脓肿的抗感染治疗进展

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中，以链球菌、葡萄球菌最多，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。

Progress in medical treatment of bacterial brain abscess

Bacterial brain abscess 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 attack rate is rather low, it may lead to severe consequences, even lethal. In terms of etiology, there is a correlation between predisposing factors in patients and pathogens that cause the infection, among which, Streptococcus and Staphylococcus are the most common. In China, so as in Asia, Gram-negative bacilli also make a large part. In clinical practice, the combination of the third generation of cephalosporins and metronidazole, which covers the majority of bacteria that cause brain abscess, is the most commonly used empirical regimen. Basically, the treatment of bacterial brain abscess 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 medical treatment, is the major therapy of brain abscess, which may reduce the duration of treatment. Conservative treatment can be adoptable under some circumstances, such as when 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, till nowadays, there is insufficient evidence about medical treatment of bacterial brain abscess in many aspects.