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埃塞俄比亚西北部儿科病房细菌性脑膜炎的治疗结果及决定因素:一项多中心研究

Treatment outcome and determinant factors of bacterial meningitis at pediatric ward: a multicenter study from Northwest Ethiopia.

作者信息

Siraj Ebrahim Abdela, Tebikew Mekuanint, Abay Hilina, Kebede Selamawit Yimer, Tafere Chernet, Bahiru Bereket, Demsie Dessalegn Getnet, Gizachew Beselam, Bizuneh Gizachew Kassahun, Motbaynor Gizachew, Yismaw Malede Berihun, Agmassie Zegaye, Yayehrad Ashagrachew Tewabe, Addisu Zenaw Debasu

机构信息

Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.

Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.

出版信息

Sci Rep. 2025 Apr 25;15(1):14417. doi: 10.1038/s41598-025-91340-1.

Abstract

Meningitis is a serious health condition with varied treatment outcomes that can be affected due to a difference in demographic factors, clinical conditions, and treatment associated factors. The following study assess the factors to identify predicting factors for affecting the treatment outcomes. The study was done on 423 patients with meningitis retrospectively through chart review on selected hospitals from September 2022 to February 2023. The information obtained from the patient chart including demographic information, clinical state and comorbid conditions were analyzed. Logistic regression was used to identify factors associated with treatment outcomes. The larger proportion of patients (79.2%) were with the age of ≥ 2 months, with males account 52.5% of all study participants. The most common symptoms experienced by the patients were fever (85.8%), irritability (63.1%), and neck rigidity (71.2%). More than half of the participants (57.9%) has a minimum of one comorbid health condition, with pneumonia being the most prevalent comorbid disease (20.6%). In terms of treatment considered, gentamycin (31.9%) and ampicillin (31.1%) were frequently indicated, whereas antibiotic regimen changes were required in 31.9% of meningitis patients. The majority of the patients (75.7%) showed good outcomes with improvement, nevertheless around 24.3% experienced poor outcomes, including death (2.1%) and extended length of stay in hospitals (5.9%). Predicting factors for poor outcomes like delayed access to treatment initiation (Adjusted Odds Ratio (AOR = 4.24, p = 0.001)), existence of comorbidities (AOR = 4.21, p < 0.001), and absence of dexamethasone use (AOR = 2.33, p = 0.002). Though many patients presented with good treatment outcomes, lately seeking treatment options, the presence of comorbid conditions significantly affects the prognosis. The study findings indicated that early diagnosis and efficient treatment strategies of comorbid conditions and proper use of combined therapies such as dexamethasone meaningfully improve the treatment outcomes.

摘要

脑膜炎是一种严重的健康状况,其治疗结果各不相同,可能会因人口统计学因素、临床状况和治疗相关因素的差异而受到影响。以下研究评估了这些因素,以确定影响治疗结果的预测因素。该研究于2022年9月至2023年2月期间,通过对选定医院的病历进行回顾性研究,对423例脑膜炎患者进行了研究。分析了从患者病历中获得的信息,包括人口统计学信息、临床状态和合并症。采用逻辑回归分析确定与治疗结果相关的因素。大部分患者(79.2%)年龄≥2个月,男性占所有研究参与者的52.5%。患者最常见的症状是发热(85.8%)、易怒(63.1%)和颈部僵硬(71.2%)。超过一半的参与者(57.9%)至少有一种合并健康状况,其中肺炎是最常见的合并疾病(20.6%)。在考虑的治疗方面,庆大霉素(31.9%)和氨苄西林(31.1%)使用频繁,而31.9%的脑膜炎患者需要更换抗生素治疗方案。大多数患者(75.7%)治疗效果良好,病情有所改善,但仍有24.3%的患者治疗效果不佳,包括死亡(2.1%)和住院时间延长(5.9%)。治疗延迟(调整优势比(AOR=4.24,p=0.001))、存在合并症(AOR=4.21,p<0.001)和未使用地塞米松(AOR=2.33,p=0.002)是治疗效果不佳的预测因素。尽管许多患者治疗效果良好,但就诊较晚、存在合并症会显著影响预后。研究结果表明,早期诊断、有效治疗合并症以及合理使用地塞米松等联合疗法可显著改善治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f74a/12032015/13e3722a739c/41598_2025_91340_Fig1_HTML.jpg

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