Auteur : MOUFFAK Amina
Rapporteur : Pr. SEKHSOKH Yassine
Mots clés : Antibiothérapie, Méningite Nosocomiale, Postopératoire, Prévention.
Les méningites nosocomiales postopératoires sont des complications graves de la neurochirurgie avec une mortalité et une morbidité importantes. Elles posent des problèmes en termes de diagnostic et de traitement.
De très nombreux facteurs de risque liés au patient, à l’intervention ou à la technique chirurgicale dont la fuite de liquide céphalorachidien, le drainage postopératoire, favorisent leur survenue soit en postopératoire immédiat ou plusieurs semaines après l’intervention. Le diagnostic est difficile, car la symptomatologie clinique est peu parlante, le trépied méningitique manque souvent, mais généralement on note la présence de fièvre avec des troubles de la conscience.
Sur le plan biologique l’analyse de la pleiocytose du liquide céphalorachidien n’est pas aisée dans ce contexte postopératoire.
L’examen bactériologique isole le plus souvent les bacilles à gram négatifs et les staphylocoques.
Le traitement antibiotique doit être instauré en urgence, initialement de manière probabiliste selon le contexte clinique et l’écologie du service, ensuite adapté aux résultats des examens bactériologiques. Il fait appel surtout aux céphalosporines de 3eme génération et les fluoroquinolones caractérisées par la bonne diffusion à travers la barrière hémato-méningée. La prévention des méningites nosocomiales postopératoires pose un défi important, surtout avec l’émergence des agents pathogènes multi résistants. Elle se base essentiellement sur les mesures d’hygiène hospitalière et l’antibioprophylaxie.
Le pronostic dépend essentiellement de la rapidité de la prise en charge et l’existence de comorbidités.
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Summary
Title : Postoperative nosocomial meningitis
Author : MOUFFAK Amina
Tutor : Pr.SEKHSOKH Yassine
Keywords : Antibiotic ,Meningitis Nosocomial, Postoperative, Prevention.
Postoperative nosocomial meningitis is a serious complication of neurosurgery with significant mortality and morbidity. They pose problems in terms of diagnosis and treatment. Very many risk factors related to the patient, the intervention or belonging to the surgical technique whose cerebrospinal fluid leak , postoperative drainage , promote their occurrence either immediately postoperatively or several weeks after the intervention .
The diagnosis is difficult, because clinical symptomatology is poorly speaking, the meningitic tripod is often missing, but generally there is the presence of fever with disturbances of consciousness.
From a biological point of view, the analysis of pleiocytosis of cerebrospinal fluid is not easy in this context postoperative.
Bacteriological examination most often isolates gram-negative bacilli and staphylococci. Antibiotic treatment must be instituted urgently, initially in a probabilistic manner according to the clinical context and the ecology of the service, then adapted to the results of the bacteriological examinations. It mainly involves 3rd generation cephalosporins and fluoroquinolones characterized by good diffusion across the blood-brain barrier.
The prevention of postoperative nosocomial meningitis poses a major challenge, especially with the emergence of multidrug-resistant pathogens. It is mainly based on hospital hygiene measures and antibiotic prophylaxis.
The prognosis depends essentially on the speed of treatment and the existence of comorbidities.
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:ناﻮﻨﻌﻟا ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻠﻤﻌﻟا ﺪﻌﺑ ﻲﺋﺎﻔﺸﺘﺳﻹاﺎﯾﺎﺤﺴﻟا بﺎﮭﺘﻟا :ﺔﻔﻟﺆﻤﻟا ﻖﻓﻮﻤﻟا ﺔﻨﯿﻣأ فﺮﺸﻤﻟا خﻮﺴﺨﺳ ﻦﯿﺳﺎﯾ ذﺎﺘﺳﻷا : ﺔﯿﺳﺎﺳﻷا تﺎﻤﻠﻜﻟا ، ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻠﻤﻌﻟا ﺪﻌﺑ ، ﻲﺋﺎﻔﺸﺘﺳﻹا ﺎﯾﺎﺤﺴﻟا بﺎﮭﺘﻟا ،ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟﺎﺑ جﻼﻌﻟا ، : . ﺔﯾﺎﻗﻮﻟا ﻟا ﺪﻌﺑ ﻲﺋﺎﻔﺸﺘﺳﻹا ﺎﯾﺎﺤﺴﻟا بﺎﮭﺘﻟا ﺪﻌﯾ ثوﺪﺣ ﻊﻣ بﺎﺼﻋﻷا ﺔﺣاﺮﺠﻟ ةﺮﯿﻄﺨﻟا تﺎﻔﻋﺎﻀﻤﻟا ﻦﻣ ﺔﺣاﺮﺠ . ةﺮﯿﺒﻛ تﻻﻼﺘﻋاو تﺎﯿﻓو ﺺﯿﺨﺸﺘﻟا ﺚﯿﺣ ﻦﻣ تﺎﺑﻮﻌﺻ ﻞﻜﺸﺗ ﺎﮭﻧأ .جﻼﻌﻟاو بﺮﺴﺗ ﻚﻟذ ﻲﻓ ﺎﻤﺑ ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻨﻘﺘﻟا وأ ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻠﻤﻌﻟﺎﺑ ،ﺾﯾﺮﻤﻟﺎﺑ ﺔﻘﻠﻌﺘﻤﻟا ﺮﻄﺨﻟا ﻞﻣاﻮﻋ ﻦﻣ ﺮﯿﺜﻜﻟا ﺎﺴﺗ ،ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻠﻤﻌﻟا ﺪﻌﺑ فﺮﺼﻟا ،ﻲﻋﺎﺨﻨﻟا ﻞﺋﺎﺴﻟا وأ رﻮﻔﻟا ﻰﻠﻋ ﻲﺣاﺮﺠﻟا ﻞﺧﺪﺘﻟا ﺪﻌﺑ ﺎﻣإ ﺎﮭﺛوﺪﺣ ﻲﻓ ﻢھ .ﻞﺧﺪﺘﻟا ﻦﻣ ﻊﯿﺑﺎﺳأ ةﺪﻋ ﺪﻌﺑ ةدﺎﻋ ﻦﻜﻟو ، ﮫﺼﻘﻨﯾ ﺎﻣ ﺎًﺒﻟﺎﻏ ﻲﺋﺎﺤﺴﻟا ﻲﺛﻼﺜﻟﺎﻓ ، ا ً ﺮﯿﺜﻛ ﻢﻠﻜﺘﺗ ﻻ ﺔﯾﺮﯾﺮﺴﻟا ضاﺮﻋﻷا نﻷ ﺐﻌﺻ ﺺﯿﺨﺸﺘﻟا .ﻲﻋﻮﻟا تﺎﺑاﺮﻄﺿا ﻊﻣ ﻰﻤﺤﻟا دﻮﺟو ﻆﺣﻼﻧ ﺎﻣ ﻞﯿﻠﺤﺗ نﺈﻓ ، ﺔﯿﺟﻮﻟﻮﯿﺑ ﺮﻈﻧ ﺔﮭﺟو ﻦﻣ ﻟا ﺎﯾﻼﺧ ةﺮﺜﻛ قﺎﯿﺴﻟا اﺬھ ﻲﻓ ﻞﮭﺴﻟا ﺮﻣﻷﺎﺑ ﺲﯿﻟ ﻲﻋﺎﺨﻨﻟا ﻞﺋﺎﺴ . ﻲﺣاﺮﺠﻟا .ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟاو ماﺮﻐﻟا ﺔﯿﺒﻠﺳ تﺎﯿﺼﻋ نﺎﯿﺣﻷا ﺐﻟﺎﻏ ﻲﻓ لﺰﻌﯾ ﻲﻣﻮﺛﺮﺠﻟا ﺺﺤﻔﻟا ﺎً ﻘﻓو ﺔﯿﻟﺎﻤﺘﺣا ﺔﻘﯾﺮﻄﺑ ﺎًﯿﺋﺪﺒﻣ ، ﻞﺟﺎﻋ ﻞﻜﺸﺑ ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟﺎﺑ جﻼﻌﻟا ﻊﺿو ﺐﺠﯾ ﺔﺌﯿﺑو يﺮﯾﺮﺴﻟا قﺎﯿﺴﻠﻟ ﻟا ﺞﺋﺎﺘﻧ ﻊﻣ ﺎﮭﻔﯿﻜﺗ ﻢﺛ ، ﺔﻣﺪﺨﻟا ﻦﻣ ﺚﻟﺎﺜﻟا ﻞﯿﺠﻟا ﻲﺴﯿﺋر ﻞﻜﺸﺑ ﻞﻤﺸﯾ . ﺔﯿﺟﻮﻟﻮﯾﺮﺘﻜﺒﻟا صﻮﺤﻔ . غﺎﻣﺪﻟا ﻲﻓ مﺪﻟا ﺰﺟﺎﺣ ﺮﺒﻋ ﺪﯿﺟ رﺎﺸﺘﻧﺎﺑ ﺰﯿﻤﺘﺗ ﻲﺘﻟا تﺎﻧﻮﻟﻮﻨﯿﻛورﻮﻠﻔﻟاو ﻦﯾرﻮﺒﺳﻮﻟﺎﻔﯿﺴﻟا رﻮﮭظ ﻊﻣ ﺎﻤﯿﺳ ﻻ ، ا ً ﺮﯿﺒﻛ ﺎًﯾﺪﺤﺗ ﺔﯿﺣاﺮﺠﻟا ﺔﯿﻠﻤﻌﻟا ﺪﻌﺑ ﻲﺋﺎﻔﺸﺘﺳﻹا ﺎﯾﺎﺤﺴﻟا بﺎﮭﺘﻟا ﻦﻣ ﺔﯾﺎﻗﻮﻟا ﻞﻜﺸﺗ ﻸﻟ ﺔﻣوﺎﻘﻤﻟا ضاﺮﻣﻷا تﺎﺒﺒﺴﻣ ﺔﯾﺎﻗﻮﻟاو ﻰﻔﺸﺘﺴﻤﻟا ﻲﻓ ﺔﻓﺎﻈﻨﻟا ﺮﯿﺑاﺪﺗ ﻰﻠﻋ ﺎﺳﺎﺳأ ﺪﻨﺘﺴﯾو . ةدﺪﻌﺘﻤﻟا ﺔﯾود .ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟا ماﺪﺨﺘﺳﺎﺑ . ﺔﺒﺣﺎﺼﻣ ضاﺮﻣأ دﻮﺟو و ﻞﺧﺪﺘﻟا ﺔﻋﺮﺳ ﻰﻠﻋ صﻮﺼﺨﻟﺎﺑ ﻖﻠﻌﺘﯾ ضﺮﻤﻟا رﻮﻄﺗ121
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