摘要

BACKGROUND:Antibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis. METHODS AND FINDINGS:In this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification. The primary outcome was the overall AR of suspected meningitis after inclusion. A random sample of 20 participating villages was enrolled to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae before and after the intervention. Between April 22 and May 18, 2017, 49 villages were included: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis. A total of 248 cases were notified in the study after the index cases. The AR was 451 per 100,000 persons in the control arm, 386 per 100,000 persons in the household prophylaxis arm (t test versus control p = 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test versus control p = 0.032). The adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52-1.73, p = 0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19‒0.87, p = 0.022). No adverse events were notified. Baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention. One limitation of the study was the small number of cerebrospinal fluid samples sent for confirmatory testing. CONCLUSIONS:Village-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification reduced overall meningitis AR. Distributions of ciprofloxacin could be an effective tool in future meningitis outbreak responses, but further studies investigating length of protection, effectiveness in urban settings, and potential impact on antimicrobial resistance patterns should be carried out. TRIAL REGISTRATION:ClinicalTrials.gov NCT02724046.

译文

背景: 在非洲脑膜炎地带爆发期间,不建议对脑膜炎病例接触者进行抗生素预防。我们评估了单剂量口服环丙沙星给家庭接触者和全村分布对脑膜炎球菌性脑膜炎爆发总发作率 (AR) 的有效性。方法和结果: 在尼日尔 Madarounfa 区脑膜炎球菌性脑膜炎爆发期间的这项 3 臂、开放标签、分组随机试验中,通知疑似病例的村庄被随机分配 (1:1:1) 对标准护理 (控制组),在病例通知后 24 小时内为家庭接触者单剂量口服环丙沙星,或首例通报 72 小时内环丙沙星全村分布情况。主要结果是纳入后疑似脑膜炎的总体 AR。随机抽取 20 个参与村的样本,记录干预前后耐环丙沙星和产超广谱 β-内酰胺酶 (ESBL) 肠杆菌科细菌粪便携带率的任何变化。4月22日至 2017年5月18日期间,49 个村庄被包括在内: 17 个用于控制部门,17 个用于家庭预防,15 个用于全村预防。在索引案例后,研究中总共通知了 248 个案例。控制组每 451 人中 AR 为 100,000,家庭预防组每 386 人中 AR 为 100,000 (t检验与对照组 p = 0.68), 在全村预防组中,每 190 人中有 100,000 人 (t检验与对照组 p = 0.032)。家庭预防组和控制组之间的调整后的 AR 比率为 0.94 (95% CI 0.52-1.73,p = 0.85), 全村预防组和控制组之间调整后的 AR 比率为 0.40 (95% CI 0.19-0。 87,p = 0.022)。未通知不良事件。对环丙沙星耐药的肠杆菌科的基线携带率为 95%,产 ESBL 肠杆菌科的基线携带率> 90%,干预后没有变化。该研究的一个局限性是用于确认性测试的脑脊液样本数量较少。结论: 病例通知后 72 小时内单剂量口服环丙沙星的全村分布减少了整体脑膜炎 AR。环丙沙星的分布可能是未来脑膜炎爆发反应的有效工具,但是应该进行进一步的研究,调查保护的长度、城市环境中的有效性以及对抗菌药物耐药性模式的潜在影响。试验注册: ClinicalTrials.gov nct02724046。

Meningitis

儿科 炎症疾病 疾病
概述  :  

软脑膜的弥漫性炎症性改变。由细菌、病毒、真菌、螺旋体、原虫、立克次体、肿瘤与白血病等各种生物性致病因子侵犯软脑膜和脊髓膜引起。化脓性脑膜炎是各种化脓性细菌引起的脑膜炎症。部分患儿病变累及脑实质,是小儿尤其是婴幼儿时期常见的中枢神经系统感染性疾病。临床以急性发热、烦躁不安、意识障碍、惊厥、颅内压增高和脑膜刺激征以及脑脊液化脓性改变为特征。病因除脑膜炎双球菌、肺炎链球菌和流感嗜血杆菌以外,2个月以下幼婴、新生儿以及原发或继发性免疫缺陷病者,易发生肠道革兰阴性杆菌和金黄色葡萄球菌脑膜炎,以大肠杆

meningitis 英 /ˌmenɪnˈdʒaɪtɪs/ 美 /ˌmenɪnˈdʒaɪtɪs/

释    义   n. 脑膜炎

例    句   There is no known way to prevent meningitis , it is therefore important to be aware of the dangersigns. 有没有已知的办法,防止脑膜炎,因此,这是重要的是要意识到危险的迹象。

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