Progress has been made in the prevention and treatment of community-acquired bacterial meningitis during the past three decades but the burden of the disease remains high globally. Conjugate vaccines against the three most common causative pathogens (Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae) have reduced the incidence of disease, but with the replacement by non-vaccine pneumococcal serotypes and the emergence of bacterial strains with reduced susceptibility to antimicrobial treatment, meningitis continues to pose a major health challenge worldwide. In patients presenting with bacterial meningitis, typical clinical characteristics (such as the classic triad of neck stiffness, fever, and an altered mental status) might be absent and cerebrospinal fluid examination for biochemistry, microscopy, culture, and PCR to identify bacterial DNA are essential for the diagnosis. Multiplex PCR point-of-care panels in cerebrospinal fluid show promise in accelerating the diagnosis, but diagnostic accuracy studies to justify routine implementation are scarce and randomised, controlled studies are absent. Early administration of antimicrobial treatment (within 1 hour of presentation) improves outcomes and needs to be adjusted according to local emergence of drug resistance. Adjunctive dexamethasone treatment has proven efficacy beyond the neonatal age but only in patients from high-income countries. Further progress can be expected from implementing preventive measures, especially the development of new vaccines, implementation of hospital protocols aimed at early treatment, and new treatments targeting checkpoints of the inflammatory cascade.

在过去的三十年里，社区获得性细菌性脑膜炎的预防和治疗取得了进展，但全球范围内的疾病负担仍然很高。针对三种最常见致病病原体（肺炎链球菌、脑膜炎奈瑟菌和流感嗜血杆菌）的结合疫苗) 降低了疾病的发病率，但随着非疫苗肺炎球菌血清型的替代以及对抗菌治疗敏感性降低的细菌菌株的出现，脑膜炎继续对全世界的健康构成重大挑战。在出现细菌性脑膜炎的患者中，可能不存在典型的临床特征（例如颈部僵硬、发热和精神状态改变的经典三联征），并且脑脊液检查以进行生化、显微镜检查、培养和 PCR 以识别细菌 DNA 是必不可少的为诊断。脑脊液中的多重 PCR 即时检测面板在加速诊断方面显示出希望，但证明常规实施合理性的诊断准确性研究很少，而且缺乏随机对照研究。早期给予抗菌治疗（出现后 1 小时内）可改善预后，需要根据局部出现的耐药性进行调整。地塞米松辅助治疗已被证明在新生儿年龄之后有效，但仅限于来自高收入国家的患者。实施预防措施有望取得进一步进展，特别是开发新疫苗、实施旨在早期治疗的医院方案以及针对炎症级联检查点的新治疗。