Srihawan Chanunya, Castelblanco Rodrigo Lopez, Salazar Lucrecia, Wootton Susan H, Aguilera Elizabeth, Ostrosky-Zeichner Luis, Sandberg David I, Choi HuiMahn A, Lee Kiwon, Kitigawa Ryan, Tandon Nitin, Hasbun Rodrigo
Department of Internal Medicine , University of Texas Health Science Center at Houston.
Departments of Pediatrics.
Open Forum Infect Dis. 2016 Apr 13;3(2):ofw077. doi: 10.1093/ofid/ofw077. eCollection 2016 Apr.
Background. Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods. We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results. A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31-18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27-7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51-18.92; P = .01) were associated with an adverse outcome. Conclusions. Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality.
背景。医疗保健相关的脑膜炎或脑室炎是侵入性神经外科手术或穿透性头部创伤的一种严重且危及生命的并发症。方法。我们对2003年7月至2014年11月在德克萨斯州休斯顿的2家大型三级医疗中心被诊断为医疗保健相关脑膜炎或脑室炎（根据2015年疾病控制与预防中心的病例定义）的成人和儿童进行了一项回顾性研究。通过感染控制从业者以及筛查送往中央实验室的脑脊液样本确定患者。我们收集了有关人口统计学、临床表现、实验室检查结果、影像学研究、治疗方法及预后的数据。结果。总共纳入了215例患者（166例成人和49例儿童）。106例（49%）患者脑脊液培养呈阳性，大多数病原体为葡萄球菌和革兰氏阴性杆菌。167例患者（77.7%）出现不良临床结局，其中20例（9.3%）死亡，31例（14.4%）处于持续植物状态，77例（35.8%）严重残疾，39例（18.1%）中度残疾。逻辑回归分析显示，年龄>45岁（调整后的优势比[OR]，6.47；95%置信区间[CI]，2.31 - 18.11；P≤.001）、神经系统检查异常（调整后的OR，3.04；95% CI，1.27 - 7.29；P = .013）以及机械通气（调整后的OR，5.34；95% CI，1.51 - 18.92；P = .01）与不良结局相关。结论。医疗保健相关的脑膜炎或脑室炎与显著的发病率和死亡率相关。
