Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Denmark.
Clin Microbiol Infect. 2018 Feb;24(2):166-170. doi: 10.1016/j.cmi.2017.06.021. Epub 2017 Jun 24.
To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM).
We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality.
A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5).
Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.
研究社区获得性细菌性脑膜炎（CABM）患者延迟诊断的临床特征和预后。
我们对丹麦三个中心的所有成人确诊 CABM 患者进行了图表回顾，研究时间为 1998 年至 2014 年。患者分为入院时即确诊的早期诊断组和入院记录中未列出 CABM 且入院时未考虑腰椎穿刺或抗生素治疗的延迟诊断组。我们使用校正泊松回归分析计算了预测延迟诊断和住院死亡率的调整后相对风险及 95%置信区间。
共有 358 例患者中的 113 例（32%）被归类为延迟诊断，这些患者的诊断多种多样，其中 81 例（72%）为非传染性疾病。我们观察到在延迟诊断和早期诊断患者之间存在一些统计学上显著的基线差异（p <0.05），包括年龄> 65 岁（56/113，50%比 67/245，27%）、颈项强直（35/97，36%比 183/234，78%）、合并肺炎（26/113，23%比 26/245，11%）和脑膜炎球菌性脑膜炎（6/113，5%比 52/245，21%）。多变量分析中这些变量仍具有统计学意义。此外，延迟诊断与住院死亡率增加相关（41/113，36%比 43/245，18%；校正后相对风险 1.7，95%CI 1.2-2.5）。
CABM 的延迟诊断很常见，患者入院时的诊断大多为非传染性疾病。颈项强直缺失并不能排除 CABM 的可能，应特别注意肺炎和老年人患者。延迟诊断与错误的患者管理相关，并增加了死亡率。
