Department of Neurology, Kennemer Gasthuis, Haarlem, The Netherlands.
PLoS One. 2010 Feb 8;5(2):e9102. doi: 10.1371/journal.pone.0009102.
Alcoholism is associated with susceptibility to infectious disease, particularly bacterial pneumonia. In the present study we described characteristics in alcoholic patients with bacterial meningitis and delineate the differences with findings in non-alcoholic adults with bacterial meningitis.
METHODS/PRINCIPAL FINDINGS: This was a prospective nationwide observational cohort study including patients aged >16 years who had bacterial meningitis confirmed by culture of cerebrospinal fluid (696 episodes of bacterial meningitis occurring in 671 patients). Alcoholism was present in 27 of 686 recorded episodes of bacterial meningitis (4%) and alcoholics were more often male than non-alcoholics (82% vs 48%, P = 0.001). A higher proportion of alcoholics had underlying pneumonia (41% vs 11% P<0.001). Alcoholics were more likely to have meningitis due to infection with Streptococcus pneumoniae (70% vs 50%, P = 0.01) and Listeria monocytogenes (19% vs 4%, P = 0.005), whereas Neisseria meningitidis was more common in non-alcoholic patients (39% vs 4%, P = 0.01). A large proportion of alcoholics developed complications during clinical course (82% vs 62%, as compared with non-alcoholics; P = 0.04), often cardiorespiratory failure (52% vs 28%, as compared with non-alcoholics; P = 0.01). Alcoholic patients were at risk for unfavourable outcome (67% vs 33%, as compared with non-alcoholics; P<0.001).
CONCLUSIONS/SIGNIFICANCE: Alcoholic patients are at high risk for complications resulting in high morbidity and mortality. They are especially at risk for cardiorespiratory failure due to underlying pneumonia, and therefore, aggressive supportive care may be crucial in the treatment of these patients.
酗酒与易感染传染病有关，尤其是细菌性肺炎。在本研究中，我们描述了患有细菌性脑膜炎的酗酒患者的特征，并阐述了其与非酗酒性成人细菌性脑膜炎的差异。
方法/主要发现：这是一项全国性前瞻性观察队列研究，纳入了年龄>16 岁且经脑脊液培养证实为细菌性脑膜炎的患者（671 例患者中有 696 例发生细菌性脑膜炎）。在 686 例细菌性脑膜炎记录病例中，有 27 例（4%）存在酗酒，酗酒者中男性多于非酗酒者（82%比 48%，P = 0.001）。更多的酗酒者有基础肺炎（41%比 11%，P<0.001）。与非酗酒者相比，酗酒者更有可能因感染肺炎链球菌（70%比 50%，P = 0.01）和李斯特菌（19%比 4%，P = 0.005）而导致脑膜炎，而非脑膜炎奈瑟菌在非酗酒者中更常见（39%比 4%，P = 0.01）。在病程中，大量酗酒者发生并发症（82%比 62%，与非酗酒者相比；P = 0.04），常伴有心肺衰竭（52%比 28%，与非酗酒者相比；P = 0.01）。酗酒者的预后不良风险较高（67%比 33%，与非酗酒者相比；P<0.001）。
酗酒者易发生并发症，导致高发病率和高死亡率。他们尤其有因基础肺炎而导致心肺衰竭的风险，因此，积极的支持性治疗可能是治疗这些患者的关键。
