Luque-Paz David, Revest Matthieu, Eugène François, Boukthir Sarrah, Dejoies Loren, Tattevin Pierre, Le Reste Pierre-Jean
Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France.
Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France.
Open Forum Infect Dis. 2021 Apr 29;8(6):ofab216. doi: 10.1093/ofid/ofab216. eCollection 2021 Jun.
Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature.
This is a retrospective, single-center study. We screened the medical files of all patients who had a brain imaging report that included the word "ventriculitis" during years 2005-2019. Only patients with clinical, microbiological, and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire.
Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, and the median age was 60 years (interquartile range, 48-68). The primary mechanism for ventriculitis was classified as follows: brain abscess (n = 29, 29.6%), meningitis (n = 27, 27.6%), intraventricular catheter-related (n = 17, 17.3%), post-neurosurgery (n = 13, 13.3%), and hematogenous (n = 12, 12.2%). The main neuroimaging features were intraventricular pus (n = 81, 82.7%), ependymal enhancement (n = 70, 71.4%), and intraventricular loculations (n = 15, 15.3%). The main pathogens were streptococci (n = 44, 44.9%), Gram-negative bacilli (n = 27, 27.6%), and staphylococci (n = 15, 15.3%). In-hospital and 1-year mortality rates were 30.6% (n = 30) and 38.8% (n = 38), respectively. Neurological sequelae were reported in 34 of 55 (61.8%) survivors, including cognitive impairment (n = 11), gait disturbances (n = 9), paresis (n = 7), behavior disorder (n = 6), and epilepsy (n = 5). On multivariate analysis, age >65 years, Glasgow Coma Scale score <13 at initial presentation, status epilepticus, hydrocephalus, and positive cerebrospinal fluid culture were associated with 1-year mortality. We built a scoring system to stratify patients with ventriculitis into low risk (12.5%), intermediate risk (36.5%), and high risk (71.4%) of death.
Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with an in-hospital mortality rate of 30% and neurological sequelae in 60% of survivors.
脑室炎是脑脓肿、脑膜炎及各种神经外科手术可怕的并发症，在医学文献中受到的关注有限。
这是一项回顾性单中心研究。我们筛查了2005年至2019年间所有有包含“脑室炎”一词的脑成像报告的患者的病历。仅纳入具有脑室炎临床、微生物学和影像学特征的患者。通过标准化问卷收集数据。
98例患者符合纳入标准：女性42例，男性56例，中位年龄为60岁（四分位间距，48 - 68岁）。脑室炎的主要病因分类如下：脑脓肿（n = 29，29.6%）、脑膜炎（n = 27，27.6%）、脑室内导管相关（n = 17，17.3%）、神经外科手术后（n = 13，13.3%）和血行性（n = 12，12.2%）。主要神经影像学特征为脑室内积脓（n = 81，82.7%）、室管膜强化（n = 70，71.4%）和脑室内分隔（n = 15，15.3%）。主要病原体为链球菌（n = 44，44.9%）、革兰氏阴性杆菌（n = 27，27.6%）和葡萄球菌（n = 15，15.3%）。住院死亡率和1年死亡率分别为30.6%（n = 30）和38.8%（n = 38）。55例幸存者中有34例（61.8%）报告有神经后遗症，包括认知障碍（n = 11）、步态障碍（n = 9）、轻瘫（n = 7）、行为障碍（n = 6）和癫痫（n = 5）。多因素分析显示，年龄>65岁、初始就诊时格拉斯哥昏迷量表评分<13、癫痫持续状态、脑积水和脑脊液培养阳性与1年死亡率相关。我们建立了一个评分系统，将脑室炎患者分为低死亡风险（12.5%）、中度死亡风险（36.5%）和高死亡风险（71.4%）。
脑室炎是脑脓肿、脑膜炎或神经外科手术的严重并发症，住院死亡率为30%，60%的幸存者有神经后遗症。
