成人细菌性脑膜炎：8 年间芬兰一所大学医院 148 例患者的回顾性研究。
Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland.
机构信息
Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Savitehtaankatu 5, 20540, Turku, Finland.
Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
出版信息
BMC Infect Dis. 2023 Jan 23;23(1):45. doi: 10.1186/s12879-023-07999-2.
BACKGROUND
Bacterial meningitis (BM) causes significant morbidity and mortality. We investigated predisposing factors, clinical characteristics, spectrum of etiological bacteria, and clinical outcome of community-acquired and nosocomial BM.
METHODS
In this retrospective study we analyzed data of 148 adults (age > 16 years) with BM treated in Turku University Hospital, Southwestern Finland, from 2011 to 2018. Besides culture- or polymerase chain reaction (PCR)-positive cases we also included culture-negative cases with laboratory parameters strongly suggestive of BM and those with meningitis-related findings in imaging. We used Glasgow Outcome Scale (GOS) score 1-4 to determine unfavorable outcome.
RESULTS
The median age of patients was 57 years and 48.6% were male. Cerebrospinal fluid (CSF) culture for bacteria showed positivity in 50 (33.8%) cases, although pre-diagnostic antibiotic use was frequent (85, 57.4%). The most common pathogens in CSF culture were Streptococcus pneumoniae (11, 7.4%), Staphylococcus epidermidis (7, 4.7%), Staphylococcus aureus (6, 4.1%) and Neisseria meningitidis (6, 4.1%). Thirty-nine patients (26.4%) presented with the triad of fever, headache, and neck stiffness. A neurosurgical procedure or an acute cerebral incident prior BM was recorded in 74 patients (50%). Most of the patients had nosocomial BM (82, 55.4%) and the rest (66, 44.6%) community-acquired BM. Ceftriaxone and vancomycin were the most used antibiotics. Causative pathogens had resistances against the following antibiotics: cefuroxime with a frequency of 6.8%, ampicillin (6.1%), and tetracycline (6.1%). The case fatality rate was 8.8% and the additional likelihood of unfavorable outcome 40.5%. Headache, decreased general condition, head computed tomography (CT) and magnetic resonance imaging (MRI), hypertension, altered mental status, confusion, operative treatment, neurological symptoms, pre-diagnostic antibiotic use and oral antibiotics on discharge were associated with unfavorable outcome.
CONCLUSIONS
The number of cases with nosocomial BM was surprisingly high and should be further investigated. The usage of pre-diagnostic antibiotics was also quite high. Headache was associated with unfavorable outcome. The frequency of unfavorable outcome of BM was 40.5%, although mortality in our patients was lower than in most previous studies.
背景
细菌性脑膜炎（BM）会导致严重的发病率和死亡率。我们研究了社区获得性和医院获得性 BM 的易患因素、临床特征、病因细菌谱以及临床结果。
方法
在这项回顾性研究中，我们分析了 2011 年至 2018 年在芬兰西南部图尔库大学医院治疗的 148 例年龄大于 16 岁的成人 BM 患者的数据。除了培养或聚合酶链反应（PCR）阳性病例外，我们还包括实验室参数强烈提示 BM 的培养阴性病例，以及影像学检查中有脑膜炎相关发现的病例。我们使用格拉斯哥预后量表（GOS）评分 1-4 来确定不良预后。
结果
患者的中位年龄为 57 岁，48.6%为男性。脑脊液（CSF）培养对细菌呈阳性的有 50 例（33.8%），尽管预诊断抗生素的使用很常见（85 例，57.4%）。CSF 培养中最常见的病原体是肺炎链球菌（11 例，7.4%）、表皮葡萄球菌（7 例，4.7%）、金黄色葡萄球菌（6 例，4.1%）和脑膜炎奈瑟菌（6 例，4.1%）。39 例（26.4%）出现发热、头痛和颈部僵硬三联征。74 例（50%）患者在 BM 前有神经外科手术或急性脑事件。大多数患者为医院获得性 BM（82 例，55.4%），其余（66 例，44.6%）为社区获得性 BM。头孢曲松和万古霉素是最常用的抗生素。病原体对以下抗生素有耐药性：头孢呋辛 6.8%，氨苄西林（6.1%）和四环素（6.1%）。病死率为 8.8%，不良预后的可能性增加 40.5%。头痛、一般状况恶化、头部 CT 和 MRI、高血压、意识状态改变、意识模糊、手术治疗、神经症状、预诊断抗生素使用和出院时口服抗生素与不良预后相关。
结论
医院获得性 BM 的病例数量出人意料地高，需要进一步研究。预诊断抗生素的使用也相当高。头痛与不良预后相关。BM 的不良预后发生率为 40.5%，尽管我们患者的死亡率低于大多数先前的研究。
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