Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Am Geriatr Soc. 2022 Jul;70(7):2060-2069. doi: 10.1111/jgs.17766. Epub 2022 Mar 29.
Advanced age is a risk factor for unfavorable outcome in community-acquired bacterial meningitis, but clinical characteristics and outcome in meningitis patients of 80 years or older have not been defined.
We compared clinical characteristics and outcome of community-acquired bacterial meningitis patients aged 80 years or older and adults under 80 years old within a prospective nationwide cohort study.
Out of 2140 episodes identified between March 2006 and July 2018, 149 occurred in patients aged 80 years or older (7%). Common predisposing factors other than age were diabetes mellitus (25 of 148 [17%]), otitis or sinusitis (30 of 136 [22%]), and pneumonia (23 of 141 [16%]). The triad of fever, neck stiffness and altered consciousness was present in 60 of 139 (43%). The most common causative pathogen was Streptococcus pneumoniae (99 of 149 [66%]). Atypical causative pathogens, such as Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli, occurred more often compared to younger patients (49 of 149 [33%] vs 362 of 1991 [18%]; p < 0.001). Patients of 80 years and older had high case fatality rate (75 of 149 [50%]), but 45 of 149 (30%) had a favorable outcome. Characteristics associated with an unfavorable outcome were absence of otitis or sinusitis, presence of aphasia, mono- or hemiparesis, a lower score on the Glasgow Coma Scale, a higher heart rate, a higher blood C-reactive protein concentration and CSF leukocytes <100 per mm .
Bacterial meningitis in patients of 80 years of older is associated with high rates of unfavorable outcome and death. Atypical causative pathogens such as L. monocytogenes, S. aureus, and E. coli occur commonly and should be considered when starting empirical antimicrobial therapy in this age group.
高龄是社区获得性细菌性脑膜炎不良预后的危险因素，但 80 岁及以上脑膜炎患者的临床特征和预后尚未明确。
我们在一项前瞻性全国性队列研究中比较了 80 岁及以上和 80 岁以下社区获得性细菌性脑膜炎患者的临床特征和预后。
在 2006 年 3 月至 2018 年 7 月期间确定的 2140 例发作中，有 149 例发生在 80 岁及以上的患者（7%）。除年龄外，常见的易患因素包括糖尿病（136 例中的 25 例，22%）、中耳炎或鼻窦炎（139 例中的 30 例，22%）和肺炎（141 例中的 23 例，16%）。发热、颈部僵硬和意识改变三联征见于 139 例中的 60 例（43%）。最常见的病原体是肺炎链球菌（149 例中的 99 例，66%）。与年轻患者相比，更常出现非典型病原体，如李斯特菌、金黄色葡萄球菌和大肠杆菌（149 例中的 49 例，33%，与 1991 例中的 362 例，18%相比；p<0.001）。80 岁及以上患者的病死率较高（149 例中的 75 例，50%），但 45 例（30%）预后良好。与不良预后相关的特征包括无中耳炎或鼻窦炎、存在失语症、单瘫或偏瘫、格拉斯哥昏迷评分较低、心率较高、血 C 反应蛋白浓度较高和 CSF 白细胞<100 个/mm³。
80 岁及以上患者的细菌性脑膜炎不良预后和死亡率较高。李斯特菌、金黄色葡萄球菌和大肠杆菌等非典型病原体常见，在该年龄组开始经验性抗菌治疗时应考虑这些病原体。
