Cuenca M, de Andrés R, de Górgolas M, Gadea I, Molleja A S, Fernández Guerrero M L
Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Madrid.
Rev Clin Esp. 1997 Sep;197(9):618-22.
To analyze the causative factors, clinical and microbiological characteristics, and prognosis in spontaneous meningitis caused by Gram-negative rods in adult patients.
Descriptive and retrospective study of all clinical records and microbiological findings in patients diagnosed of meningitis by Gram-negative bacilli, from 1973 to 1995, at Fundación Jiménez Díaz.
Twenty patients had spontaneous meningitis caused by Gram-negative bacilli (2.1% of all diagnosed meningitis during this period). Fourteen patients were older than 65 years (range: 36-81; p < 0.05). Ninety-five percent of cases had an extranosocomial origin (p < 0.001). Ninety percent of patients had some underlying disease (p < 0.001). Twelve patients were immunosuppressed. Seven patients had changes in the urinary tract or repeated UTI infections. The most common clinical symptoms were a decrease in consciousness level, fever, and neck stiffness. Cerebrospinal fluid (CSF) in 18 patients showed cellular and biochemical changes. The CSF smear revealed the presence of Gram-negative bacilli in 15 patients. E. coli was the microorganism recovered most frequently. Immunosuppression (p < 0.05), septic shock (p < 0.001) and antimicrobial therapy not including a third generation cephalosporin (p < 0.01) were independently associated with mortality.
Spontaneous meningitis by Gram-negative bacilli is an uncommon infection. It occurs mainly in immunosuppressed patients older than 65 years or with changes in the urinary tract. It usually has an extranosocomial origin. The investigation of CSF is a highly effective for diagnosis. Therapy with third generation cephalosporins has notably improved its prognosis.
分析成年患者革兰氏阴性杆菌所致自发性脑膜炎的致病因素、临床及微生物学特征和预后。
对1973年至1995年在希门尼斯·迪亚斯基金会被诊断为革兰氏阴性杆菌脑膜炎患者的所有临床记录和微生物学检查结果进行描述性回顾性研究。
20例患者发生革兰氏阴性杆菌所致自发性脑膜炎（占同期所有诊断为脑膜炎患者的2.1%）。14例患者年龄大于65岁（范围：36 - 81岁；p < 0.05）。95%的病例为医院外感染源（p < 0.001）。90%的患者有某种基础疾病（p < 0.001）。12例患者免疫功能低下。7例患者有泌尿系统改变或反复发生尿路感染。最常见的临床症状是意识水平下降、发热和颈部强直。18例患者的脑脊液（CSF）显示细胞和生化改变。15例患者的脑脊液涂片显示存在革兰氏阴性杆菌。大肠杆菌是最常分离出的微生物。免疫抑制（p < 0.05）、感染性休克（p < 0.001）和未使用第三代头孢菌素的抗菌治疗（p < 0.01）与死亡率独立相关。
革兰氏阴性杆菌所致自发性脑膜炎是一种罕见感染。主要发生在65岁以上免疫功能低下患者或有泌尿系统改变者。通常为医院外感染源。脑脊液检查对诊断非常有效。第三代头孢菌素治疗显著改善了其预后。
