Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
BMC Infect Dis. 2020 Oct 7;20(1):733. doi: 10.1186/s12879-020-05462-0.
The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM.
Our retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis.
The median patient age was 36 (IQR 24-56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0-90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count <150x10e9/l.
The most common causative agent of CABM was N. meningitidis, with serotype B clearly dominant. Causative agents did not influence the disease outcome. The strongest risk factors for an unfavorable outcome were older age, pneumonia and a low platelet count. Since the introduction of routine vaccination against meningococcus B for infants in Lithuania in 2018, the national vaccination policy may hopefully contribute to a decrease in the incidence of serogroup B meningococcal disease in the Lithuanian population.
社区获得性细菌性脑膜炎（CABM）的发病率和死亡率仍然很高，必须定期评估病因、临床特征、治疗效果和不良预后的预测因素。本研究的目的是确定病因的分布及其与该队列中 CABM 患者的临床特征、治疗和结局的关系。
我们对 2009 年 1 月 1 日至 2016 年 12 月 31 日期间在维尔纽斯大学医院传染病中心住院的 159 例成人 CABM 患者的致病微生物、临床特征、实验室检查、治疗和结局进行了回顾性图表分析。格拉斯哥结局量表（GOS）评分≤3 定义为不良结局。通过逻辑回归分析确定不良结局的预测因素。
中位患者年龄为 36（IQR 24-56），51.6%为男性。在 80 例（50.3%）患者中确定了微生物学确诊的病原体：脑膜炎奈瑟菌 55 例（34.6%），其中血清型 B 占 85%，肺炎链球菌 15 例（9.4%），单核细胞增生李斯特菌 5 例（3.1%），其他 5 例（3.1%）。59.1%的患者存在发热、颈部僵硬和精神状态改变的三联征。根据病因分层，所有组的共存疾病和合并症相似。初始抗菌治疗包括青霉素 78 例（49.1%）和头孢曲松 72 例（45.3%）。抗生素治疗开始的中位时间为 40 分钟（IQR 30.0-90.0）。15.7%的病例结局不良，5.7%的病例死亡，死因与病原体无关。不良结局的危险因素为年龄>65 岁、合并肺炎和血小板计数<150x10e9/l。
CABM 最常见的病原体是脑膜炎奈瑟菌，血清型 B 明显占优势。病原体不影响疾病结局。不良结局的最强危险因素是年龄较大、肺炎和血小板计数低。自 2018 年立陶宛为婴儿常规接种 B 型脑膜炎球菌疫苗以来，国家疫苗接种政策有望降低立陶宛人群中 B 型脑膜炎奈瑟菌疾病的发病率。
