Laguna-Del-Estal P, García-Madero R, Gil-Navarro M, García-Zubiri C, Agud-Fernández M
Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
Rev Clin Esp. 2010 Feb;210(2):57-64. doi: 10.1016/j.rce.2009.07.002.
The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients.
We reviewed the meningitis cases diagnosed at our hospital (1982-2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged > or =60) and young adults (aged 14-59).
Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often (p=0,002), had higher protein level (p=0,023) and higher percentage of positive cerebrospinal fluid culture (p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common (p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age > or =years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age > or =75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality.
In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications.
急性细菌性脑膜炎（ABM）的年龄分布已从儿童转向成人。与此同时，老年人口正在增加。本研究的目的是描述老年患者的ABM特征。
我们回顾了我院（1982 - 2006年）诊断的脑膜炎病例，包括根据既定标准定义的ABM病例。分析了两组：老年患者（年龄≥60岁）和年轻成人（年龄14 - 59岁）。
239例ABM中有95例（40%）在老年患者中诊断，而144例（60%）在年轻成人中发现。在老年人中，32%为医院获得性感染，49%有术后危险因素，24%为自发性感染。45%的患者出现发热、颈部僵硬和精神状态改变的组合。老年人更常出现精神状态改变（p = 0.002），蛋白水平更高（p = 0.023），脑脊液培养阳性率更高（p = 0.039）。最常见的病原体是肺炎链球菌（20%）、凝固酶阴性葡萄球菌（14%）和单核细胞增生李斯特菌（8%），而病因不明的脑膜炎较少见（p = 0.014）。老年患者死亡率更高（19%对6%，p = 0.001），这与以下因素密切相关：年龄≥75岁、精神状态改变、无头痛或呕吐、出现并发症和全身并发症以及金黄色葡萄球菌感染。在多变量模型中，年龄≥75岁[OR = 6.65；p = 0.008]、无头痛[OR = 0.15；p = 0.003]和出现并发症[OR = 4.55；p = 0.015]仍然与死亡率显著相关。
在老年人中，ABM影响有危险因素的患者，主要由肺炎链球菌引起。这个年龄组死亡率更高，这与高龄和并发症的出现有关。
