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Akutversorgung von Patienten mit bakterieller Meningitis

Acute care of patients with bacterial meningitis

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Zusammenfassung

Hintergrund

Die bakterielle Meningitis ist ein lebensbedrohlicher septischer Notfall, der unverändert mit einer hohen Mortalität assoziiert ist und häufig zu einer Behinderung führt.

Ziel

Dieser Beitrag soll einen Überblick über Klinik, diagnostisches Vorgehen, Therapie und Prognose der bakteriellen Meningitis bieten. Es werden positiv beeinflussbare Prognosefaktoren identifiziert und Empfehlungen zum konzertierten Vorgehen in der Akutsituation und zur Behandlung von Komplikationen gegeben.

Material und Methoden

Der Beitrag basiert auf einer Literaturrecherche in PubMed und Leitlinien sowie auf eigenen Erfahrungen („standard operating procedures“).

Ergebnisse

Trotz Verbesserung der medizinischen Versorgung führt die bakterielle Meningitis weiterhin häufig zum Tod oder zu einer Behinderung. Die Letalität hat sich in den letzten Jahrzehnten kaum verändert. Oft wird die Erkrankung nicht rechtzeitig erkannt und/oder die Therapie verzögert eingeleitet, was sich direkt negativ auf das Behandlungsergebnis auswirkt. Intensivpflichtige neurologische und nichtneurologische Komplikationen sind häufig und treten rasch oder auch deutlich verzögert auf.

Schlussfolgerung

Für eine Senkung der Letalität und Behinderung ist ein unverzüglicher Therapiebeginn entscheidend. Die erste Antibiotikagabe sollte innerhalb von 30 min nach Krankenhausaufnahme erfolgen. Hierfür ist ein konzertiertes Vorgehen in der Akutsituation nötig. Intra- wie auch extrakraniale Komplikationen bedürfen (neuro-)intensivmedizinischer Kompetenz und nicht selten einer interdisziplinären Behandlung.

Abstract

Background

Bacterial meningitis is a life-threatening emergency that is still associated with high mortality and poor outcome.

Objective

The purpose of this article is to provide a review of clinical presentation, diagnostic procedure, therapy, and prognosis in bacterial meningitis. Prognostic factors which could be influenced positively are identified and a focused procedure in the emergency setting and for the treatment of complications are provided.

Material and methods

This work is based on a literature search (PubMed, guidelines) and personal experience (standard operating procedures, SOP).

Results

Despite improved health care, bacterial meningitis is still associated with high mortality and poor neurological outcome, which has remained largely unaltered during recent decades. Diagnosis and, more importantly, effective therapy of bacterial meningitis are often delayed, having an immediate negative influence on clinical outcome. Neurological and nonneurological complications often necessitate intensive care and may occur rapidly or in the further course of the disease.

Conclusion

Immediate initiation of effective therapy is crucial to positively influence mortality and neurological outcome. Antibiotics should be administered within 30 min after admission. To achieve this, a focused and well-organized procedure in the emergency setting is necessary. Because of intra- and extracranial complications, patients need to be treated on intensive care units including neurological expertise and interdisciplinary support.

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Authors and Affiliations

  1. Abteilung für Neurologie, Universitätsklinikum Köln, Kerpener Str. 62, 50924, Köln, Deutschland

    H.R. Stetefeld &  C. Dohmen

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  1. H.R. Stetefeld
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  2. C. Dohmen
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Correspondence to H.R. Stetefeld.

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C. Dohmen und H.R. Stetefeld geben an, dass kein Interessenkonflikt besteht.

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Stetefeld, H., Dohmen, C. Akutversorgung von Patienten mit bakterieller Meningitis. Med Klin Intensivmed Notfmed 111, 215–223 (2016). https://doi.org/10.1007/s00063-015-0021-3

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