2016 年至 2020 年南非急性细菌性脑膜炎的病死率和后遗症。

Case-fatality and sequelae following acute bacterial meningitis in South Africa, 2016 through 2020.

机构信息

Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.

出版信息

Int J Infect Dis. 2022 Sep;122:1056-1066. doi: 10.1016/j.ijid.2022.07.068. Epub 2022 Aug 5.

DOI:10.1016/j.ijid.2022.07.068

PMID:35934172

Abstract

OBJECTIVES

Providing country-specific estimates of case fatality and sequelae from bacterial meningitis (BM) is important to evaluate and monitor progress toward the World Health Organization's roadmap to "defeating meningitis by 2030".

METHODS

From 2016-2020, GERMS-SA conducted enhanced surveillance at 26 hospitals across South Africa. Episodes of laboratory-confirmed BM due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis were included. Risk factors for in-hospital death and sequelae at hospital discharge among survivors were analyzed.

RESULTS

Of 12,717 invasive bacterial infections reported nationally, 39% (4980) were from enhanced surveillance sites, including 4159 pneumococcal, 640 H. influenzae, and 181 meningococcal infections. BM accounted for 32% (1319/4159) of pneumococcal, 21% (136/640) of H. influenzae, and 83% (151/181) of meningococcal invasive diseases. Clinical data were available for 91% (1455/1606) of BM: 26% (376/1455) were aged <5 years, 50% (726/1455) were female, and 62% (723/1171) with known HIV results, were HIV-infected. In-hospital case fatality was 37% (534/1455), and 24% (222/921) of survivors had adverse sequelae. Risk factors for death included altered mental status, HIV infection, and comorbidities. Risk factors for adverse sequelae included altered mental status and antimicrobial nonsusceptibility.

CONCLUSION

BM in South Africa has a high case fatality, and adverse sequelae frequently occur among survivors. Those with comorbidities (including HIV) are at the highest risk.

摘要

目的

提供特定国家细菌性脑膜炎（BM）病死率和后遗症的估计值对于评估和监测世卫组织“到 2030 年战胜脑膜炎”路线图的进展情况非常重要。

方法

2016 年至 2020 年期间，GERMS-SA 在南非的 26 家医院开展了强化监测。包括实验室确诊的由肺炎链球菌、流感嗜血杆菌和脑膜炎奈瑟菌引起的 BM 病例。分析幸存者住院期间死亡和出院时后遗症的风险因素。

结果

全国报告的 12717 例侵袭性细菌感染中，39%（4980 例）来自强化监测点，包括 4159 例肺炎球菌、640 例流感嗜血杆菌和 181 例脑膜炎球菌感染。BM 占肺炎球菌的 32%（1319/4159），流感嗜血杆菌的 21%（136/640）和脑膜炎球菌侵袭性疾病的 83%（151/181）。BM 的临床数据可用于 91%（1455/1606）的病例：26%（376/1455）年龄<5 岁，50%（726/1455）为女性，62%（723/1171）已知 HIV 结果为 HIV 感染。住院病死率为 37%（534/1455），24%（222/921）幸存者有不良后遗症。死亡的危险因素包括意识改变、HIV 感染和合并症。不良后遗症的危险因素包括意识改变和抗菌药物不敏感。