Kiyani Musa, Hodges Sarah E, Adil Syed M, Charalambous Lefko T, Liu Beiyu, Lee Hui-Jie, Parente Beth, Perfect John R, Lad Shivanand P
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
Neurol Clin Pract. 2021 Apr;11(2):117-126. doi: 10.1212/CPJ.0000000000000868.
To examine the longitudinal health care resource utilization, in-hospital mortality, and incidence of downstream complications of bacterial meningitis in the United States.
Using IBM MarketScan, we retrieved data on adult patients with a diagnosis of bacterial meningitis admitted to a US hospital between 2008 and 2015. Patients were stratified into groups (1) with/without prior head trauma/neurosurgical complications, (2) nosocomial/community acquisition, and (3) Gram-negative/positive bacteria. Cost data were collected for up to 2 years and analyzed with descriptive statistics and longitudinal modeling.
Among 4,496 patients with bacterial meningitis, 16.5% and 4.6% had preceding neurosurgical complications and head injuries, respectively. Lumbar punctures were performed in 37.3% of patients without prior trauma/complications who went on to develop nosocomial meningitis, and those with prior head injuries or complications had longer initial hospital stays (17.0 days vs 8.0 days). Within a month of diagnosis, 29.2% of patients with bacterial meningitis had experienced downstream complications, most commonly hydrocephalus (12.7%). The worst 30-day mortality was due to tuberculous (12.3%) and streptococcal meningitis (7.2%). Overall, prior head trauma and complications were associated with higher costs. Community-acquired bacterial meningitis had lower median baseline costs relative to the nosocomial group (no head trauma/complication: $17,152 vs $82,778; head trauma/complication: $92,428 vs $168,309) but higher median costs within 3 months of diagnosis (no head trauma/complication: $47,911 vs $34,202; head trauma/complication: $89,207 vs $58,947). All costs demonstrated a sharp decline thereafter.
Bacterial meningitis remains costly and devastating, especially for those who experience traumatic head injuries or have a complicated progress after neurosurgery.
研究美国细菌性脑膜炎患者的长期医疗资源利用情况、院内死亡率及下游并发症的发生率。
利用IBM MarketScan数据库，我们检索了2008年至2015年间美国医院收治的诊断为细菌性脑膜炎的成年患者的数据。患者被分为以下几组：（1）有/无既往头部外伤/神经外科并发症；（2）医院获得性/社区获得性；（3）革兰氏阴性/阳性菌感染。收集长达2年的费用数据，并采用描述性统计和纵向模型进行分析。
在4496例细菌性脑膜炎患者中，分别有16.5%和4.6%的患者有既往神经外科并发症和头部损伤。在未发生过创伤/并发症且随后发生医院获得性脑膜炎的患者中，37.3%进行了腰椎穿刺，有既往头部损伤或并发症的患者初始住院时间更长（17.0天对8.0天）。在诊断后的一个月内，29.2%的细菌性脑膜炎患者出现了下游并发症，最常见的是脑积水（12.7%）。30天死亡率最高的是结核性脑膜炎（12.3%）和链球菌性脑膜炎（7.2%）。总体而言，既往头部外伤和并发症与更高的费用相关。与医院获得性组相比，社区获得性细菌性脑膜炎的基线费用中位数较低（无头部外伤/并发症：17,152美元对82,778美元；有头部外伤/并发症：92,428美元对168,309美元），但在诊断后3个月内的费用中位数较高（无头部外伤/并发症：47,911美元对34,202美元；有头部外伤/并发症：89,207美元对58,947美元）。此后所有费用均急剧下降。
细菌性脑膜炎仍然代价高昂且具有破坏性，尤其是对于那些经历过创伤性头部损伤或神经外科手术后病情复杂的患者。
