Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Centre, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung County, Taiwan.
J Clin Neurosci. 2010 Mar;17(3):334-8. doi: 10.1016/j.jocn.2009.06.019. Epub 2010 Jan 25.
A total of 46 patients (nine post-neurosurgical, 37 spontaneous) with adult bacterial meningitis (ABM) caused by Klebsiellapneumoniae infection were included in this study. The nine patients in the post-neurosurgical K. pneumoniae ABM group (seven male, two female) had a mean age of 48.9 years. Two patients in this group also had diabetes mellitus (DM) and one had liver disease. The most common presentation of patients in post-neurosurgical K. pneumoniae ABM group was fever (nine patients), followed by altered consciousness (seven patients) and hydrocephalus (six patients). With medical and/or surgical treatment, a mortality of 22.2% (2/9) occurred. Compared to patients who had spontaneous K. pneumoniae ABM, those with the post-neurosurgical form had a lower incidence of community-acquired infection, seizure and DM, but had a higher incidence of leukocytosis, hydrocephalus, cerebrospinal fluid leak and bacterial strains with extended-spectrum beta-lactamase. Univariate analysis found these clinical differences to be statistically significant, however they were not significant on multivariate analysis. This study reveals that there are clinical differences between the post-neurosurgical and spontaneous presentations of K. pneumoniae ABM.
本研究共纳入 46 例由肺炎克雷伯菌引起的成人细菌性脑膜炎（ABM）患者（神经外科术后 9 例，自发性 37 例）。神经外科术后肺炎克雷伯菌 ABM 组的 9 例患者（7 例男性，2 例女性）平均年龄为 48.9 岁。该组中有 2 例合并糖尿病，1 例合并肝病。神经外科术后肺炎克雷伯菌 ABM 组患者最常见的表现为发热（9 例），其次为意识改变（7 例）和脑积水（6 例）。经内科和/或外科治疗，死亡率为 22.2%（2/9）。与自发性肺炎克雷伯菌 ABM 患者相比，神经外科术后患者社区获得性感染、癫痫和糖尿病的发病率较低，但白细胞增多、脑积水、脑脊液漏和产超广谱β-内酰胺酶的细菌株的发病率较高。单因素分析发现这些临床差异具有统计学意义，但多因素分析无统计学意义。本研究表明，肺炎克雷伯菌 ABM 的神经外科术后和自发性表现之间存在临床差异。
