Laguna del Estal P, Salgado Marqués R, Calabrese Sánchez S, Murillas Angoitti J, Martín Alvarez E, Moya Mir M S
Departamento de Medicina, Clínica Puerta de Hierro, Universidad Autónoma, Madrid.
An Med Interna. 1996 Nov;13(11):520-6.
Characterize clinical findings and outcome of acute bacterial meningitis (ABM) in adults, with special emphasis on nosocomial meningitis and meningitis in the elderly.
We reviewed the charts of all persons 14 years of age or older in whom ABM was diagnosed in our hospital during a 12 and a half-year period.
Ninety-seven patients were treated for 100 episodes of ABM, of which 23 percent were nosocomial and 27 percent occurred in elderly persons. Predisposing factors were present in 59 percent of the episodes. Fifty-four percent had the classic triad of fever, nuchal rigidity, and change in mental status. Cerebrospinal fluid pleocytosis with a neutrophilic predominance, hypoglycorrhachia, and elevated protein levels were present in 62 percent of the episodes. A pathogen was identified in 62 percent of the cases, in a higher frequency in elderly persons (p < 0.05) and in patients who had not received antibiotics before the lumbar puncture (p < 0.05). Causal agents more frequently identified were: Streptococcus pneumoniae (27 percent) in community-acquired meningitis, coagulase-negative Staphylococci (35 percent) in nosocomial meningitis, and Strep. pneumoniae (33 percent) in elderly persons. Central nervous system (CNS) complications occurred in 18 percent of episodes, and 15 percent developed systemic complications. The overall mortality rate was 9 percent, higher among patients in whom CNS complications began within 24 hours of admission (p < 0.05).
A high proportion of cases of ABM in adults are nosocomial, or affect elderly persons. The fatality rate is high, particularly among those who develop CNS complications at the onset of the disease.
描述成人急性细菌性脑膜炎（ABM）的临床特征及转归，特别关注医院获得性脑膜炎和老年人脑膜炎。
我们回顾了我院在12年半期间确诊为ABM的所有14岁及以上患者的病历。
97例患者共接受了100次ABM治疗，其中23%为医院获得性，27%发生在老年人中。59%的病例存在易感因素。54%的患者有发热、颈项强直和精神状态改变这一典型三联征。62%的病例脑脊液白细胞增多且以中性粒细胞为主，脑脊液糖含量降低，蛋白水平升高。62%的病例中鉴定出病原体，在老年人（p<0.05）和腰椎穿刺前未接受抗生素治疗的患者中频率更高（p<0.05）。更常见的病原体为：社区获得性脑膜炎中肺炎链球菌（27%），医院获得性脑膜炎中凝固酶阴性葡萄球菌（35%），老年人中肺炎链球菌（33%）。18%的病例发生中枢神经系统（CNS）并发症，15%出现全身并发症。总死亡率为9%，在入院24小时内开始出现CNS并发症的患者中更高（p<0.05）。
成人ABM病例中很大一部分为医院获得性，或累及老年人。死亡率很高，尤其是在疾病发作时出现CNS并发症的患者中。
