Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Infect. 2017 Apr;74(4):352-357. doi: 10.1016/j.jinf.2017.01.001. Epub 2017 Jan 5.
To study clinical features and outcome of community-acquired bacterial meningitis in alcoholic patients.
Patients with a history of alcoholism were selected from our nationwide, prospective cohort on community-acquired bacterial meningitis performed from March 2006 to October 2014. Data on patient history, symptoms and signs on admission, treatment, and outcome were prospectively collected.
Of 1359 included episodes, 88 episodes (6%) occurred in 88 alcoholic patients. Seizures as presenting symptom were present in 18% alcoholic patients, and 23% presented with co-existing pneumonia. Causative organisms were Streptococcus pneumoniae in 76%, Listeria monocytogenes in 8%, and Neisseria meningitidis in 6% of patients. A high rate of systemic complications occurred with respiratory failure in 40% and endocarditis in 9% of patients. Outcome was unfavorable in 58% of alcoholic patients, and 25% died. Alcoholism was associated with unfavorable outcome in a multivariate analysis (OR 1.96; 95% CI 1.12-3.46; P = 0.019), but not with death (OR 0.76; 95% CI 0.35-1.68; P = 0.762).
Alcoholic bacterial meningitis patients often have an unfavorable outcome, which appears to result from a high rate of systemic complications, mainly respiratory failure. Seizures are common in alcoholic patients and warrant caution of development of an alcohol withdrawal syndrome.
研究酒精性社区获得性细菌性脑膜炎患者的临床特征和预后。
我们从 2006 年 3 月至 2014 年 10 月进行了一项全国性的社区获得性细菌性脑膜炎前瞻性队列研究，选择其中有酗酒史的患者。前瞻性收集患者的病史、入院时的症状和体征、治疗和预后数据。
在纳入的 1359 例患者中，有 88 例（6%）发生在 88 例酒精性患者中。18%的酒精性患者以癫痫发作作为首发症状，23%同时伴有肺炎。病原体为肺炎链球菌 76%，李斯特菌属 8%，脑膜炎奈瑟菌 6%。40%的患者出现呼吸衰竭等全身并发症，9%的患者发生心内膜炎。58%的酒精性患者预后不良，25%死亡。多变量分析显示，酒精中毒与不良预后相关（OR 1.96；95% CI 1.12-3.46；P=0.019），但与死亡无关（OR 0.76；95% CI 0.35-1.68；P=0.762）。
酒精性细菌性脑膜炎患者的预后往往不佳，这似乎是由于全身并发症发生率高，主要是呼吸衰竭所致。癫痫发作在酒精性患者中很常见，需要警惕酒精戒断综合征的发生。
