快樂小藥師 Im pharmacist nichts glücklich

資料來源：NEJM  

van de Beek et al. 362 (2): 146, Figure 1     January 14, 2010

Bacteria may enter the meninges and subarachnoid space from contiguous sites of colonization or foci of suppuration after craniotomy (Panel A). Cerebrospinal fluid (CSF) catheters (Panel B) have a proximal portion that enters the cerebrospinal fluid space and a distal portion that may also be internal, terminating in the peritoneal, pleural, or vascular space, or that may be external, when the need for the catheter is temporary. Cerebrospinal fluid catheters may become infected by retrograde infection from the distal end of the shunt, wound or skin breakdown overlying the catheter, metastatic infection in patients with bacteremia, or colonization of the catheter at the time of surgery. Concentrations of leukocytes, antibodies, and complement components in the subarachnoid space are low, facilitating multiplication of bacteria (Panel C). After head trauma, microorganisms may enter the subarachnoid space through direct invasion as a result of the trauma or, in the case of a basilar skull fracture, through a dural tear, which may provide an avenue for invasion of the central nervous system by bacteria located in the auditory canal, nose, or nasopharynx (Panel D). Bacteria may also be introduced by lumbar puncture (Panel E).