Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas.
J Am Geriatr Soc. 2017 Dec;65(12):2646-2650. doi: 10.1111/jgs.15099. Epub 2017 Oct 4.
BACKGROUND/OBJECTIVES: Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Older adults are at higher risk of adverse outcomes in community-acquired meningitis but studies of HCAMV are lacking. Therefore, we perform the study to define the differences in clinical outcomes between older and younger adults with HCAMV.
Retrospective study.
A large tertiary care hospital in Houston, Texas, from July 2003 to November 2014.
Adults with a diagnosis of HCAMV (N = 160) aged ≥65 (n = 35), aged 18-64 (n = 125).
Demographic characteristics, clinical presentation, laboratory results, treatments, and outcomes (Glasgow Outcome Scale).
Older adults had more comorbidities and CSF abnormalities [pleocytosis, high cerebrospinal fluid (CSF) protein, low CSF glucose) and were more likely to have altered mental status than younger adults (P < .05). An adverse clinical outcome was seen in 142 participants (89%) (death (n = 18, 11%), persistent vegetative state (n = 26, 16%), severe disability (n = 68, 43%), moderate disability (n = 30, 19%). There was no difference in adverse outcomes between older (97%) and younger (86%) adults (P = .13). On logistic regression analysis, abnormal neurological examination (adjusted odds ratio (aOR) = 7.13, 95% confidence interval (CI) = 2.15-23.63, P = .001) and mechanical ventilation (aOR = 11.03, 95% CI = 1.35-90.51, P = .02) were associated with adverse clinical outcomes.
Older adults with HCAMV have more comorbidities and CSF abnormalities and are more likely to have altered mental status than younger adults but have similar high rates of adverse clinical outcomes.
背景/目的：医疗相关性脑膜炎或脑室炎（HCAMV）是侵袭性神经外科手术或穿透性头部外伤的严重且危及生命的并发症。老年人在社区获得性脑膜炎中发生不良结局的风险更高，但 HCAMV 的研究却很少。因此，我们进行这项研究以确定老年和年轻的 HCAMV 患者之间临床结局的差异。
回顾性研究。
德克萨斯州休斯顿的一家大型三级保健医院，时间为 2003 年 7 月至 2014 年 11 月。
年龄≥65 岁（n = 35）和 18-64 岁（n = 125）诊断为 HCAMV 的成年人。
人口统计学特征、临床表现、实验室结果、治疗方法和结局（格拉斯哥结局量表）。
老年患者合并症更多，CSF 异常（细胞增多症、高 CSF 蛋白、低 CSF 葡萄糖），且精神状态改变的可能性高于年轻患者（P <.05）。142 名参与者（89%）出现不良临床结局（死亡 18 例（11%）、持续植物状态 26 例（16%）、严重残疾 68 例（43%）、中度残疾 30 例（19%））。老年组（97%）和年轻组（86%）的不良结局无差异（P =.13）。在 logistic 回归分析中，异常的神经系统检查（调整后的优势比（aOR）= 7.13，95%置信区间（CI）= 2.15-23.63，P =.001）和机械通气（aOR = 11.03，95%CI = 1.35-90.51，P =.02）与不良临床结局相关。
与年轻患者相比，HCAMV 的老年患者合并症更多，CSF 异常更常见，精神状态改变的可能性更高，但不良临床结局的发生率同样很高。
