ACUTE BACTERIAL-MENINGITIS IN ADULTS - A REVIEW OF 493 EPISODES
ACUTE BACTERIAL-MENINGITIS IN ADULTS - A REVIEW OF 493 EPISODES
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DOI：
10.1056/nejm199301073280104
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发表时间：
1993-01-07
影响因子：
158.5
通讯作者：
SWARTZ, MN
中科院分区：
文献类型：
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作者：
DURAND, ML;CALDERWOOD, SB;SWARTZ, MN
背景和方法。为了描述成人急性细菌性脑膜炎的特征，我们回顾了1962年至1988年在马萨诸塞州总医院诊断为急性细菌性脑膜炎的所有16岁或16岁以上患者的病历。我们纳入了在其他医院接受初步治疗后入院的患者。在27年的时间里，445名成年人接受了493次急性细菌性脑膜炎的治疗，其中197次（40%）是医院感染。革兰氏阴性杆菌（除流感嗜血杆菌外）引起33%的医院感染，但仅占社区感染的3%。在296例社区获得性脑膜炎中，最常见的病原体是肺炎链球菌（37%），脑膜炎奈瑟菌（13%）和单核细胞增生李斯特菌（10%）;这些微生物仅占医院发病的8%。在493例脑膜炎中，只有19例（4%）是由H。流感。9%的患者有复发性脑膜炎，许多人有脑脊液漏。23%的社区获得性脑膜炎患者发生癫痫发作，28%的患者有局灶性中枢神经系统发现。单次社区获得性脑膜炎患者死亡的风险因素包括年龄较大（大于或等于60岁）、入院时精神状态迟钝以及最初24小时内癫痫发作。在那些单次发病的患者中，社区获得性脑膜炎的住院死亡率为25%，医院获得性脑膜炎为35%。总病死率为25%，在27年中没有显著变化。在我们的大型城市医院，成人急性细菌性脑膜炎病例的主要比例是院内感染。脑膜炎经常复发。总死亡率仍然很高。
Background and Methods. To characterize acute bacterial meningitis in adults, we reviewed the charts of all persons 16 years of age or older in whom acute bacterial meningitis was diagnosed at Massachusetts General Hospital from 1962 through 1988. We included patients who were admitted after initial treatment at other hospitals.Results. During the 27-year period, 445 adults were treated for 493 episodes of acute bacterial meningitis, of which 197 (40 percent) were nosocomial. Gram-negative bacilli (other than Haemophilus influenzae) caused 33 percent of the nosocomial episodes but only 3 percent of the community-acquired episodes. In the 296 episodes of community-acquired meningitis, the most common pathogens were Streptococcus pneumoniae (37 percent), Neisseria meningitidis (13 percent), and Listeria monocytogenes (10 percent); these organisms accounted for only 8 percent of the nosocomial episodes. Only 19 of the 493 episodes of meningitis (4 percent) were due to H. influenzae. Nine percent of all patients had recurrent meningitis; many had a cerebrospinal fluid leak. Seizures occurred in 23 percent of patients with community-acquired meningitis, and 28 percent had focal central nervous system findings. Risk factors for death among those with single episodes of community-acquired meningitis included older age (greater-than-or-equal-to 60 years), obtunded mental state on admission, and seizures within the first 24 hours. Among those with single episodes, the in-hospital mortality rate was 25 percent for community-acquired and 35 percent for nosocomial meningitis. The overall case fatality rate was 25 percent and did not vary significantly over the 27 years.Conclusions. In our large urban hospital, a major proportion of cases of acute bacterial meningitis in adults were nosocomial. Recurrent episodes of meningitis were frequent. The overall mortality rate remained high.