Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2013 Aug;46(4):259-65. doi: 10.1016/j.jmii.2012.07.006. Epub 2012 Aug 24.
BACKGROUND/PURPOSE: Serratia marcescens is a rare pathogen of central nervous system infections. This study was to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis.
This retrospective analysis included 33 patients with culture-proven S. marcescens meningitis hospitalized between January 2000 and June 2011.
Of the 33 patients enrolled, only one did not receive neurosurgery before the onset of S. marcescens meningitis. Patients with S. marcescens meningitis had higher ratios of brain solid tumors (54.5%) and neurosurgery (97.0%) with a mortality rate of 15.2%. The mean interval between the first neurosurgical procedure and the diagnosis of meningitis was 17.1 days (range, 4-51 days). Only one third-generation cephalosporin-resistant S. marcescens isolate was recovered from the patients' cerebrospinal fluid (CSF) specimens. Compared with the favorable outcome group (n = 20), the unfavorable outcome group (n = 13) had a higher percentage of brain solid tumors, more intensive care unit stays, and higher Sequential Organ Failure Assessment score, CSF lactate and serum C-reactive protein concentrations at diagnosis of meningitis. Under the multiple regression analysis, CSF lactate concentration ≥2-fold the upper limit of normal (ULN) was independently associated with unfavorable outcomes (odds ratio, 7.20; 95% confidence interval, 1.08-47.96; p = 0.041).
S. marcescens meningitis is highly associated with neurosurgical procedures for brain solid tumors. CSF lactate concentration ≥2x ULN may predict an unfavorable outcome. Its mortality is not high and empiric treatment with parenteral third-generation cephalosporins may have a satisfactory clinical response.
背景/目的：粘质沙雷氏菌是中枢神经系统感染的罕见病原体。本研究旨在探讨粘质沙雷氏菌脑膜炎的流行病学、预后因素和治疗结果。
本回顾性分析纳入了 2000 年 1 月至 2011 年 6 月期间住院的 33 例经培养证实的粘质沙雷氏菌脑膜炎患者。
33 例患者中，仅有 1 例在粘质沙雷氏菌脑膜炎发病前未接受神经外科手术。粘质沙雷氏菌脑膜炎患者脑实体瘤（54.5%）和神经外科手术（97.0%）的比例较高，死亡率为 15.2%。首次神经外科手术后至诊断为脑膜炎的平均时间间隔为 17.1 天（范围，4-51 天）。仅从患者的脑脊液（CSF）标本中分离出 1 株三代头孢菌素耐药的粘质沙雷氏菌。与预后良好组（n=20）相比，预后不良组（n=13）脑实体瘤比例较高，入住重症监护病房时间更长，诊断为脑膜炎时的序贯器官衰竭评估评分、CSF 乳酸和血清 C 反应蛋白浓度更高。在多因素回归分析中，CSF 乳酸浓度≥正常上限（ULN）的 2 倍与不良预后独立相关（比值比，7.20；95%置信区间，1.08-47.96；p=0.041）。
粘质沙雷氏菌脑膜炎与脑实体瘤的神经外科手术高度相关。CSF 乳酸浓度≥2xULN 可能预示不良预后。其死亡率不高，经验性给予第三代头孢菌素静脉治疗可能具有良好的临床反应。
