181例成人社区获得性急性细菌性脑膜炎病原学、临床预后及危险因素分析
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摘要
目的了解成人社区获得性急性细菌性脑膜炎患者的病原学组成、临床预后及危险因素,为临床合理诊治提供依据。方法对2010年1月至2018年1月确诊的181例社区获得性成人急性细菌性脑膜炎住院患者进行回顾性分析,比较非老年组(<65岁,n=156)及老年组(≥65岁,n=25)患者的病原学组成及临床特征;以出院时患者的情况为截点,比较两组患者的预后及危险因素。结果 181例患者中有64例患者(35.4%)检出病原菌,前三位分别为肺炎链球菌(17.9%),单核细胞增生李斯特菌(13.4%),肺炎克雷伯菌(10.5%)。统计分析显示老年组高血压患病率、低钾血症患病率、肺部感染率、耳鼻喉感染率、CSF蛋白浓度、头部CT检查的异常率、病死率均高于非老年组(P<0.05)。Logistic回归分析发现肺部感染和体温≥38.5℃是非老年组预后不良的独立危险因素,CSF压力≥200mmH2O是老年组预后不良的独立危险因素。结论引起成人社区获得性急性细菌性脑膜炎感染的病原体主要是肺炎链球菌、单核细胞增生李斯特菌、肺炎克雷伯菌。≥65岁老年患者较<65岁患者病死率更高,肺部感染是65岁以下患者、CSF压力≥200mmH2O是65岁及以上患者预后不良的独立危险因素。
Objective To understand the etiology,clinical prognosis and risk factors of adult communityacquired acute bacterial meningitis(ABM)and provide the evidence for clinical diagnosis and treatment.MethodsWe performed a retrospective study of 181 clinically diagnosed hospitalized patients with community-acquired adult ABM from Jan.2010 to Jan.2018.The patients were categorized as non-elderly(16≤age<65 years old,n=156)and elderly(age≥65 years old,n=25)group.The etiology,clinical features,prognosis and risk factors of the two groups were compared.Results Sixty-four of 181 patients(35.4%)had pathogens detected.The most common pathogens were Streptococcus pneumoniae(17.9%),Listeria monocytogenes(13.4%)and Klebsiella pneumoniae(10.5%).The mortality of the elderly group was higher than that of the non-elderly group(P<0.05).Univariate analysis showed that there was a significant difference between the elderly group and the non-elderly group in the incidence of hypertension,hypokalemia,pulmonary infection,ear-nose-throat(ENT)infection,cerebrospinal fluid(CSF)protein concentration,head CT abnormalities and mortality.Logistic regression analysis showed that pulmonary infection and temperature≥38.5 ℃ were independent risk factors for poor prognosis in the non-elderly group.CSF pressure ≥200 mmH2 O was a independent risk factors for poor prognosis in the elderly group.Conclusion The pathogens that cause acute bacterial meningitis in adult community are mainly Streptococcus pneumoniae,Listeria monocytogenes and Klebsiella pneumoniae.Pulmonary infection and temperature≥38.5 ℃are independent risk factors of poor prognosis in the non-elderly patients,as CSF pressure ≥200 mmH2 O a independent risk factor in the elderly patients.
Objective To understand the etiology,clinical prognosis and risk factors of adult communityacquired acute bacterial meningitis(ABM)and provide the evidence for clinical diagnosis and treatment.MethodsWe performed a retrospective study of 181 clinically diagnosed hospitalized patients with community-acquired adult ABM from Jan.2010 to Jan.2018.The patients were categorized as non-elderly(16≤age<65 years old,n=156)and elderly(age≥65 years old,n=25)group.The etiology,clinical features,prognosis and risk factors of the two groups were compared.Results Sixty-four of 181 patients(35.4%)had pathogens detected.The most common pathogens were Streptococcus pneumoniae(17.9%),Listeria monocytogenes(13.4%)and Klebsiella pneumoniae(10.5%).The mortality of the elderly group was higher than that of the non-elderly group(P<0.05).Univariate analysis showed that there was a significant difference between the elderly group and the non-elderly group in the incidence of hypertension,hypokalemia,pulmonary infection,ear-nose-throat(ENT)infection,cerebrospinal fluid(CSF)protein concentration,head CT abnormalities and mortality.Logistic regression analysis showed that pulmonary infection and temperature≥38.5 ℃ were independent risk factors for poor prognosis in the non-elderly group.CSF pressure ≥200 mmH2 O was a independent risk factors for poor prognosis in the elderly group.Conclusion The pathogens that cause acute bacterial meningitis in adult community are mainly Streptococcus pneumoniae,Listeria monocytogenes and Klebsiella pneumoniae.Pulmonary infection and temperature≥38.5 ℃are independent risk factors of poor prognosis in the non-elderly patients,as CSF pressure ≥200 mmH2 O a independent risk factor in the elderly patients.
引文
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[4]VENKATESAN A.Epidemiology and outcomes of acute encephalitis.Curr Opin Neurol,2015,28(3):277-282.
[5]ELLEN JO,BARON MPW,MICHAEL DUNNEW,Jr,et al.Blood CulturesⅣ.1st edition.King of Prussia:Rittenheuse Book Distributors.2005.
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[7]刘亚玲,龚玉萍,毛碧蓉,等.人感染猪链球菌病脑膜炎型临床特点分析.华西医学,2007,22(3):548-549.
[8]LEBER AL,EVERHART K,BALADA-LLASAT JM,et al.Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of bacteria,viruses,and yeast in cerebrospinal fluid specimens.J Clin Microbiol,2016,54(9):2251-2261.
[9]王丽,张元刚,胡亚卓,等.CT与MRI对中枢神经系统感染的诊断价值比较.中国医学创新,2016,13(20):60-62.
[10]VAN DE BEEK D,DE GANS J,SPANJAARD L,et al.Clinical features and prognostic factors in adults with bacterial meningitis.N Engl J Med,2004,351(18):1849-1859.
[11]ADRIANI KS,ROUWER MC,VAN DE BEEK.Risk factors for community-acquired bacterial meningitis in adults.Neth J Med,2015,73(2):53-60.
[12]LESNAKOVA A,HOLECKOVA K,KOLENOVA,et al.Bacterial meningitis after sinusitis and otitis media:ear,nose,throat infections are still the commonest risk factors for the community acquired meningitis.Neuro Endocrinol Lett,2007,28(3):14-15.
[2]SIGURDARDOTTIR B,BJORNSSON OM,JONSDOTTIR KE,et al.Acute bacterial meningitis in adults.A 20-year overview.Arch Intern Med,1997,157(4):425-430.
[3]VAN DE BEEK D,CABELLOS C,DZUPOVA O,et al.ESCMID guideline:diagnosis and treatment of acute bacterial meningitis.Clin Microbiol Infect,2016,22(3):S37-S62.
[4]VENKATESAN A.Epidemiology and outcomes of acute encephalitis.Curr Opin Neurol,2015,28(3):277-282.
[5]ELLEN JO,BARON MPW,MICHAEL DUNNEW,Jr,et al.Blood CulturesⅣ.1st edition.King of Prussia:Rittenheuse Book Distributors.2005.
[6]DERY MA,HASBUN R.Changing epidemiology of bacterial meningitis.Curr Infect Dis Rep,2007,9(4):301-307.
[7]刘亚玲,龚玉萍,毛碧蓉,等.人感染猪链球菌病脑膜炎型临床特点分析.华西医学,2007,22(3):548-549.
[8]LEBER AL,EVERHART K,BALADA-LLASAT JM,et al.Multicenter evaluation of BioFire FilmArray meningitis/encephalitis panel for detection of bacteria,viruses,and yeast in cerebrospinal fluid specimens.J Clin Microbiol,2016,54(9):2251-2261.
[9]王丽,张元刚,胡亚卓,等.CT与MRI对中枢神经系统感染的诊断价值比较.中国医学创新,2016,13(20):60-62.
[10]VAN DE BEEK D,DE GANS J,SPANJAARD L,et al.Clinical features and prognostic factors in adults with bacterial meningitis.N Engl J Med,2004,351(18):1849-1859.
[11]ADRIANI KS,ROUWER MC,VAN DE BEEK.Risk factors for community-acquired bacterial meningitis in adults.Neth J Med,2015,73(2):53-60.
[12]LESNAKOVA A,HOLECKOVA K,KOLENOVA,et al.Bacterial meningitis after sinusitis and otitis media:ear,nose,throat infections are still the commonest risk factors for the community acquired meningitis.Neuro Endocrinol Lett,2007,28(3):14-15.