Ishihara Masaki, Kamei Satoshi, Taira Naoto, Morita Akihiko, Miki Kenji, Naganuma Tomoka, Minami Masayuki, Shiota Hiroshi, Hara Motohiko, Mizutani Tomohiko
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo.
Intern Med. 2009;48(5):295-300. doi: 10.2169/internalmedicine.48.1508. Epub 2009 Mar 2.
Prognostic factors related to community-acquired bacterial meningitis (BM) in adult patients have been evaluated using multivariate analysis in The Netherlands, where the rate of antibiotic resistance was low. However, an evaluation of these factors in countries with a high rate of antibiotic resistance has not yet been done. Thus, we studied the prognostic factors in adults with community-acquired BM in our hospitals, which are located in Tokyo, Japan, where the rate of antibiotic resistance is high.
We selected 71 consecutive adult patients with community-acquired BM in which the pathogens were identified and then classified the patients into two groups based on the Glasgow Outcome Scale: a favorable outcome group (n=48), and an unfavorable outcome group (n=23). Their clinical and laboratory variables were analyzed using single logistic regression analysis followed by multiple logistic regression analysis.
The overall mortality rate was 23%. The rate of antibiotic resistance was 54.9%. The most common resistant bacteria were penicillin-resistant Streptococcus pneumoniae, followed by methicillin-resistant Staphylococcus aureus. The Glasgow Coma Scale score (GCS) at the initiation of antibiotic therapy and a low thrombocyte count were identified as significant unfavorable prognostic factors (GCS: p=0.020, odds ratio=0.528, 95%CI=0.309-0.902; thrombocyte count: p=0.037, odds ratio=0.802, 95%CI=0.652-0.987). The presence of antibiotic-resistant bacteria was not identified as a prognostic factor.
Patients with a low GCS at the initiation of antibiotic therapy and low thrombocyte counts had unfavorable outcomes. With appropriate antibiotic administration, the antibiotic-resistant bacteria were not identified as an unfavorable prognostic factor, even in an area with a high rate of antibiotic resistance.
在荷兰，抗生素耐药率较低，已通过多变量分析评估了成年社区获得性细菌性脑膜炎（BM）患者的预后因素。然而，在抗生素耐药率较高的国家，尚未对这些因素进行评估。因此，我们在位于日本东京、抗生素耐药率较高的我院，研究了成年社区获得性BM患者的预后因素。
我们选取了71例连续的成年社区获得性BM患者，这些患者的病原体已被鉴定，然后根据格拉斯哥预后量表将患者分为两组：良好预后组（n = 48）和不良预后组（n = 23）。使用单因素逻辑回归分析，随后进行多因素逻辑回归分析，对他们的临床和实验室变量进行分析。
总死亡率为23%。抗生素耐药率为54.9%。最常见的耐药菌是耐青霉素肺炎链球菌，其次是耐甲氧西林金黄色葡萄球菌。抗生素治疗开始时的格拉斯哥昏迷量表评分（GCS）和低血小板计数被确定为显著的不良预后因素（GCS：p = 0.020，比值比 = 0.528，95%CI = 0.309 - 0.902；血小板计数：p = 0.037，比值比 = 0.802，95%CI = 0.652 - 0.987）。抗生素耐药菌的存在未被确定为预后因素。
抗生素治疗开始时GCS低和血小板计数低的患者预后不良。即使在抗生素耐药率较高的地区，通过适当使用抗生素，抗生素耐药菌未被确定为不良预后因素。
