Нозокомиальные менингиты и вентрикулиты: клиника, диагностика, профилактика (обзор литературы)

Цель – обобщение данных литературы о методах диагностики и профилактики нозокомиальных менингитов.

 Нозокомиальные менингиты (НМ) и вентрикулиты являются тяжелыми, нередко жизнеугрожающими осложнениями в нейрохирургии. В настоящее время выделяют послеоперационные менингиты, шунт-инфекции, дренаж-ассоциированные вентрикулиты. Для каждой из вышеперечисленных групп заболеваний существуют особенности диагностических подходов, этиотропных агентов, лечения, значительно отличающиеся от внебольничных инфекций центральной нервной системы. Возбудители представлены широким спектром условно-патогенных и патогенных микроорганизмов, существенно отличающихся от внебольничных. Диагностика НМ строится в основном на клинической оценке и лабораторном исследовании спинномозговой жидкости. В большинстве рекомендаций точные лабораторные критерии диагноза НМ отсутствуют, что объясняется вариабельностью сдвигов, зависящих от микроорганизма, вызвавшего инфекцию, и от индивидуальных особенностей пациента, а также многообразием клинических ситуаций. Профилактика НМ строится на минимизации факторов риска, включает в себя мероприятия, направленные против эндогенного и экзогенного инфицирования, и может быть разделена на три этапа: предоперационная, интраоперационная и послеоперационная. Разработка критериев НМ и вентрикулитов, выявление факторов риска остается важной проблемой, окончательно не решенной на сегодняшний день.

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