a Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
b Department of Neurosurgery , Odense University Hospital , Odense , Denmark.
Infect Dis (Lond). 2017 May;49(5):356-364. doi: 10.1080/23744235.2016.1269265. Epub 2017 Jan 3.
The aim of this study was to evaluate the clinical outcome of patients with severe bacterial meningitis where intracranial pressure (ICP) monitoring has been performed.
A retrospective observational study including patients admitted 1st January 2005 to 31st December 2014. Thirty nine patients age 18-89 years were included. All the patients received intensive care with mechanical ventilation, ICP monitoring, sedation, antibiotics and corticosteroids according to current guidelines. Clinical outcome was defined as death during hospitalization or survival at hospital discharge.
The most common pathogen was Streptococcus pneumoniae (26; 67%). Thirteen patients died (33%) and neurologic impairment was noted in twenty two (84.6%) surviving patients. In S. pneumoniae cases patients with adverse outcome were significantly older (p = 0.0024) and immunosuppressed (p = 0.034). Lower mean-cerebral perfusion pressure (CPP) was found to correlate with adverse outcome (p = 0.005). Cerebrospinal fluid (CSF) was drained in fourteen patients. Increased ICP (>20 mmHg) was observed in twenty four patients. No significant correlation was found between measured ICP and head CT scans with signs of elevated ICP.
Patients with severe meningitis should be admitted to intensive care units and evaluated for ICP monitoring regardless of head CT findings.
本研究旨在评估行颅内压（ICP）监测的严重细菌性脑膜炎患者的临床转归。
本研究为回顾性观察性研究，纳入了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间收治的患者。共纳入 39 例 18-89 岁患者。所有患者均根据现行指南接受强化护理、机械通气、ICP 监测、镇静、抗生素和皮质类固醇治疗。临床转归定义为住院期间死亡或出院时存活。
最常见的病原体是肺炎链球菌（26 例；67%）。13 例患者死亡（33%），22 例存活患者出现神经功能障碍（84.6%）。在肺炎链球菌感染病例中，预后不良的患者年龄显著较大（p=0.0024）且存在免疫抑制（p=0.034）。较低的平均脑灌注压（CPP）与不良预后相关（p=0.005）。14 例患者行脑脊液引流。24 例患者 ICP 升高（>20mmHg）。未发现有创 ICP 与提示 ICP 升高的头 CT 扫描之间存在显著相关性。
无论头 CT 结果如何，严重脑膜炎患者均应收入重症监护病房并评估行 ICP 监测的必要性。
