Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung Section, Kaohsiung, Taiwan.
Department of laboratory medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
BMC Infect Dis. 2023 Dec 6;23(1):859. doi: 10.1186/s12879-023-08857-x.
To examine the clinical characteristics of adult patients with community-acquired spontaneous bacterial meningitis (CASBM) with a fulminant clinical course.
The clinical features and therapeutic outcomes of 127 adult CASBM patients were analyzed. The patients were divided into two groups as those with and without a fulminant clinical course. Fulminant clinical course was defined as meningitis presenting initially with marked consciousness disturbance (Glasgow Coma Scale score < 8) or a rapid deterioration in consciousness level within 48 h of hospitalization.
Among the 127 enrolled patients, 69 had a fulminant clinical course (47 men and 22 women) and 58 did not. The patients with a fulminant clinical course had a significantly higher incidence of end-stage renal disease (ESRD), severe clinical manifestations and higher mortality rate, and the survivors had significantly worse therapeutic outcomes. Klebsiella (K.) pneumoniae (50 strains) was the most important pathogen for the development of a fulminant clinical course, and all strains were susceptible to ceftriaxone and ceftazidime. With treatment, 50.7% (35/69) of the patients with a fulminant clinical course died, and the presence of K. pneumoniae infection was significant prognostic factor.
The presence of ESRD, initial presentation of altered consciousness, septic shock, seizures and CSF total protein level and K. pneumoniae infection were significantly associated with a fulminant clinical course of adult CASBM, and patients with this specific infectious syndrome had high mortality and morbidity rates. The presence of K. pneumoniae infection is a significant prognostic factor.
研究成人社区获得性自发性细菌性脑膜炎（CSABM）暴发性临床病程的临床特征。
分析了 127 例成人 CSABM 患者的临床特征和治疗结果。将患者分为具有和不具有暴发性临床病程两组。暴发性临床病程定义为最初表现为明显意识障碍（格拉斯哥昏迷量表评分<8）或入院后 48 小时内意识水平迅速恶化的脑膜炎。
在纳入的 127 例患者中，69 例有暴发性临床病程（47 例男性和 22 例女性），58 例没有。暴发性临床病程患者终末期肾病（ESRD）、严重临床表现和死亡率明显更高，幸存者治疗效果明显更差。肺炎克雷伯菌（K. pneumoniae）（50 株）是导致暴发性临床病程发展的最重要病原体，所有菌株均对头孢曲松和头孢他啶敏感。经治疗，69 例暴发性临床病程患者中有 50.7%（35/69）死亡，肺炎克雷伯菌感染是显著的预后因素。
ESRD、初始意识改变、感染性休克、癫痫发作和 CSF 总蛋白水平以及肺炎克雷伯菌感染与成人 CSABM 的暴发性临床病程显著相关，具有这种特定感染综合征的患者死亡率和发病率均较高。肺炎克雷伯菌感染是一个显著的预后因素。
