成人發生的腸球菌腦膜炎(Enterococcal meningitis)很少被報導。這一篇回溯性的研究，是想了解成人腸球菌引起的腦膜炎的臨床表現及治療效果。從2000年到2012年共收集了13位天幕上的腸球菌性腦膜炎。我們蒐集並分析病患的臨床表現、腦脊髓液及血液的資料以及治療的效果。病患共有8位男性，5位女性。年齡分佈從19歲到82歲。從腦脊髓液培養出來的細菌皆為糞腸球菌(Enterococcus faecalis)。其中，11位病患有神經外科開刀的病史；兩位病患是自發性腦膜炎。發燒及意識混亂為其主要臨床表現，其次依序為白血球增加、水腦、敗血性休克、癲癇及頭痛。共有六位病患有免疫不全的狀態，包括糖尿病、惡性腫瘤或是肝硬化。在11位接受神經外科開刀病患之中，有5位除了腸球菌之外還有培養出其他細菌。整體的死亡率是38.5%。主要的治療方式為萬古黴素(vancomycin)合併第三代的頭孢菌素(cephalosporin)。臨床上，遇到接受過神經外科手術的病患，以發燒、意識變化，以及腦水腫來表現時，要注意是否為腸球菌腦膜炎。儘管接受治療，腸球菌性腦膜炎的死亡率還是很高。因此，早期發現及正確的抗生素治療對這些病患很重要。

Enterococcal meningitis in adults has rarely been reported. The aim of this retrospective study was to examine the clinical characteristics and therapeutic outcomes of adults with enterococcal meningitis. Thirteen adult patients with supratentorial enterococcal meningitis were enrolled from 2000 to 2012. Laboratory data derived from cerebrospinal fluid, clinical features and therapeutic outcomes were analyzed. There were eight males and five females, aged 19 to 82 years. The isolated pathogens cultured from cerebrospinal fluid specimens were all Enterococcus faecalis. Eleven patients had post-neurosurgical enterococcal meningitis, and two had the spontaneous form. Fever and consciousness disturbance were the most common clinical features, followed by leukocytosis, hydrocephalus, septic shock, seizure and headache. Six patients had an immunocompromised status including diabetes, malignancy and liver cirrhosis. Five patients who had undergone neurosurgical procedures had enterococcal meningitis mixed with other pathogens. The overall mortality rate was 38.5%. The majority of patients received vancomycin combined with a third-generation cephalosporin. Enterococcal meningitis should be considered especially in patients who undergo neurosurgical procedures and subsequently present with the clinical features of meningitis including fever, altered consciousness, and hydrocephalus. Despite therapeutic efforts, the mortality rate was high in the patients with enterococcal meningitis. Therefore, early recognition and appropriate antimicrobial treatment are important for these patients. (J Intern Med Taiwan 2014; 25: 424-431)