Escosteguy Claudia Caminha, Medronho Roberto de Andrade, Madruga Roberto, Dias Hellen Gruezo, Braga Ricardo Cerqueira, Azevedo Otília Pimenta
Serviço de Epidemiologia, Hospital dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
Rev Saude Publica. 2004 Oct;38(5):657-63. doi: 10.1590/s0034-89102004000500007. Epub 2004 Oct 18.
To analyze the clinical-epidemiological profile and in-hospital death predictors of infectious meningitis patients admitted to a public hospital.
There were studied 694 cases of meningitis notified and investigated by a public hospital's epidemiology service from 1986 to 2002, using the National Information System of Notifiable Diseases (SINAN) as part of the local routine of epidemiologic surveillance. Statistics analysis included multivariate logistic regression.
The most frequent etiologies were: cryptococcal (12.3%; case-fatality =37.7%); meningococcal (8.7%; fatality =13.3%); pneumococcal (7.2%; fatality =46%); tuberculous (6.1%; fatality =40.5%); staphylococcal (5.2%; fatality =38.9%), viral (5.5%; fatality =7.9%); Haemophilus (2.9%; fatality =20%). The proportion of cases of non-specified etiology was 38.8% (fatality =36%) and 17.3% were associated to HIV infection. It was found that 27.1% were nosocomial meningitis and 9.2% of the surviving cases had sequelae. The logistic regression model identified the following death predictors of infectious meningitis: etiology (reference: viral category) -- tuberculous, cryptococcal, staphylococcal, meningococcal, non-specified, other Gram-negative, Candida and pneumococcal; HIV co-infection; coma. Fever, vomiting and neck stiffness were associated to a lower odds of death.
The high proportion of non-specified etiology and high case-fatality may reflect problems in the hospital care process and/or case selection. The epidemiologic surveillance system operating at the hospital level was able to feedback the services with clinical indicators. The use of SINAN at the local level was considered useful and pertinent.
分析一家公立医院收治的感染性脑膜炎患者的临床流行病学特征及院内死亡预测因素。
对1986年至2002年期间一家公立医院流行病学服务部门报告并调查的694例脑膜炎病例进行研究，将国家法定传染病信息系统（SINAN）作为当地流行病学监测常规工作的一部分。统计分析包括多因素逻辑回归。
最常见的病因如下：隐球菌性（12.3%；病死率=37.7%）；脑膜炎球菌性（8.7%；病死率=13.3%）；肺炎球菌性（7.2%；病死率=46%）；结核性（6.1%；病死率=40.5%）；葡萄球菌性（5.2%；病死率=38.9%），病毒性（5.5%；病死率=7.9%）；嗜血杆菌性（2.9%；病死率=20%）。未明确病因的病例比例为38.8%（病死率=36%），17.3%与HIV感染相关。发现27.1%为医院获得性脑膜炎，9.2%的存活病例有后遗症。逻辑回归模型确定了感染性脑膜炎的以下死亡预测因素：病因（参考：病毒类别）——结核性、隐球菌性、葡萄球菌性、脑膜炎球菌性、未明确、其他革兰氏阴性菌、念珠菌和肺炎球菌性；HIV合并感染；昏迷。发热、呕吐和颈部僵硬与较低的死亡几率相关。
未明确病因的高比例和高病死率可能反映了医院护理过程和/或病例选择方面的问题。医院层面运行的流行病学监测系统能够向服务部门反馈临床指标。在地方层面使用SINAN被认为是有用且相关的。
