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1.
Neuro Endocrinol Lett ; 28 Suppl 3: 2-4, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030261

ABSTRACT

The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).


Subject(s)
Alcoholism/complications , Brain Damage, Chronic/etiology , Brain Injuries/complications , Gram-Negative Bacterial Infections/complications , Meningitis, Bacterial/therapy , Alcoholism/mortality , Brain Injuries/mortality , Chi-Square Distribution , Community-Acquired Infections/complications , Community-Acquired Infections/mortality , Community-Acquired Infections/therapy , Diabetes Mellitus , Gram-Negative Bacterial Infections/mortality , Gram-Negative Bacterial Infections/therapy , Humans , Meningitis, Bacterial/complications , Meningitis, Bacterial/mortality , Risk Factors , Slovakia , Treatment Failure
2.
Neuro Endocrinol Lett ; 28 Suppl 3: 7-9, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030263

ABSTRACT

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk factors such as underlying disease, cancer, diabetes alcoholism, surgery, VLBW, ENT infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared in both groups. Significant differences in etiology and risk factors between both groups were reported. Those after neurosurgery had more frequently Coagulase negative staphylococci (p<0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p<0.001), Neisseria meningitis (p<0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p<0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p<0.001) as well as otitis/sinusitis (p<0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p<0.001) but cure after modification was more common in PM (p=0.002). Therefore outcome in both groups was similar (14.6% vs. 12.4%, p=NS).


Subject(s)
Cross Infection/mortality , Meningitis, Bacterial/mortality , Postoperative Complications/mortality , Community-Acquired Infections/complications , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Cross Infection/complications , Cross Infection/microbiology , Humans , Meningitis, Bacterial/etiology , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/therapy , Neurosurgical Procedures/adverse effects , Postoperative Complications/microbiology , Risk Factors , Slovakia/epidemiology , Statistics, Nonparametric , Survival Analysis , Treatment Outcome
3.
Neuro Endocrinol Lett ; 28 Suppl 3: 12-3, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030265

ABSTRACT

Craniocerebral trauma is one of major risk factors for development of meningitis. We reviewed 30 cases of bacterial meningitis occurring in community after craniocerebral trauma. Alcohol abuse was significant risk factor occurring in trauma patients with meningitis present in 50% in our cohort (p=0.0001). The most common pathogen in posttraumatic meningitis was Str. pneumoniae (90% vs. 33.8%, p=0.0001). However mortality was very low, only 5% probably because of early diagnosis and treatment of patients at risk for bacterial meningitis but neurologic sequellea were significantly more common (p=0.00001) in patients after craniocerebral trauma.


Subject(s)
Alcohol-Related Disorders/complications , Craniocerebral Trauma/complications , Meningitis, Bacterial/etiology , Anti-Bacterial Agents/therapeutic use , Bacteria/classification , Bacteria/pathogenicity , Brain Damage, Chronic/etiology , Brain Damage, Chronic/prevention & control , Cohort Studies , Community-Acquired Infections/etiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Community-Acquired Infections/therapy , Humans , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/mortality , Meningitis, Bacterial/therapy , Outcome Assessment, Health Care , Risk Factors
4.
Neuro Endocrinol Lett ; 28 Suppl 3: 14-5, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030266

ABSTRACT

We investigated how many cases of bacterial meningitis in our national survey were associated with sinusitis or otitis media. Among 372 cases of bacterial meningitis within our nationwide 17 years survey, 201 cases were community acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were reported 1-5 weeks before onset of CBM. Diabetes mellitus (20% vs. 7.5%, p=0.01), alcohol abuse (35% vs. 15.4%, p=0.003) and trauma (30% vs. 14.9%, p=0.02) were significantly associated with CBM after ENT infections. Concerning etiology, CBM after sinusitis/otitis was insignificantly associated with pneumococcal etiology (50% vs. 33.8 %, NS) and significantly associated with other (L. monocytogenes, Str. agalactiae) bacterial agents (9.9 % vs. 25 %, p=0.008) . However those significant differences for new ENT related CBM had no impact on mortality (12.4 % vs. 5%, NS), failure after initial antibiotics (10 % vs. 9.5%, NS) and neurologic sequellae (12.5 % vs. 15.4 %, NS).


Subject(s)
Meningitis, Bacterial/etiology , Otitis Media/complications , Sinusitis/complications , Alcohol-Related Disorders/complications , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/etiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Community-Acquired Infections/therapy , Diabetes Complications , Humans , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/mortality , Meningitis, Bacterial/therapy , Otitis Media/microbiology , Outcome Assessment, Health Care , Risk Factors , Sinusitis/microbiology , Wounds and Injuries/complications
5.
Neuro Endocrinol Lett ; 28 Suppl 3: 16-7, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030267

ABSTRACT

Aim of this short communication was to assess risk factors and outcome of community acquired pneumococcal meningitis and compare it to all cases of community acquired meningitis. Univariate analysis was used for comparison of 68 pneumococcal to 201 CBM within a Slovak nationwide database of CBM. Significant risk factors for pneumococcal meningitis were previous craniocerebral trauma within 7 days (39.7% vs. 14.9%, p=0.00002), splenectomy (10.3% vs. 3.5%, p=0.03) and alcohol abuse (36.8% vs. 15.4%, p=0.0001). Concerning outcome, mortality was similar (8,8% and 12,4%, NS), proportion of those with neurologic sequellae after CBM due to Str. pneumoniae was insignificantly higher (20.6% vs. 15.4%, NS) in comparison to all CBM. All but 2 strains Str. pneumoniae were susceptible to penicillin and macrolides (3.3% resistance).


Subject(s)
Craniocerebral Trauma/complications , Meningitis, Pneumococcal/complications , Meningitis/complications , Alcohol-Related Disorders/complications , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/complications , Community-Acquired Infections/microbiology , Community-Acquired Infections/therapy , Humans , Macrolides/therapeutic use , Meningitis/therapy , Meningitis, Pneumococcal/therapy , Outcome Assessment, Health Care , Penicillins/therapeutic use , Risk Factors
6.
Neuro Endocrinol Lett ; 28 Suppl 3: 18-9, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030268

ABSTRACT

The aim of this short note is to assess gram-negative bacillary community acquired meningitis (CBM) and nosocomial meningitis (NM) within 17 years nationwide survey. All cases of gram-negative bacillary CBM within 1990-2007 were assessed in national database of 372 patients with bacterial meningitis: 69 of gram-negative cases were nosocomial and 24 of gram-negative meningitis cases were CBM. Those 24 cases were compared with all CBM (201 cases) for risk factors and outcome. Among nosocomial gram-negative pathogens, A. baumannii in 23 cases, Ps. aeruginosa in 15 cases and Enterobacteriaceae in 31 cases were isolated. Among CBM, in 13 cases Enterobacteriaceae (Escherichia coli 6, Klebsiella pneumoniae 3, Proteus mirabilis 2, Enterobacter cloacae 2), in 5 cases Ps. aeruginosa and in 6 cases Acinetobacter baumannii were isolated from cerebrospinal fluid (CSF). The only significant risk factor for CBM due to gram-negative bacilli was neonatal age (12.5% vs. 3.5%, p=0.04) as underlying disease. However, mortality among gram-negative bacillary meningitis was significantly higher (12.4% vs. 37.5%, p=0.001) in comparison to other meningitis.


Subject(s)
Cross Infection/microbiology , Gram-Negative Bacterial Infections/complications , Meningitis, Bacterial/complications , Chi-Square Distribution , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Gram-Negative Bacteria/classification , Gram-Negative Bacterial Infections/mortality , Humans , Infant, Newborn , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/mortality , Outcome Assessment, Health Care , Rare Diseases , Risk Factors
7.
Neuro Endocrinol Lett ; 28 Suppl 3: 25-6, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030272

ABSTRACT

Meningitis associated with bacteremia is rare. Bacteremic form of meningitis occurred in 28 of 201 cases of community acquired meningitis (14%) in Slovakia within last 17 years. Bacteremic meningitis was associated with diabetes (21.4% vs. 7.5%, p=0.02) and with higher treatment failures (32.1% vs. 9.5%, p=0.01) and higher mortality (25% vs. 12.4%, NS). In univariate analysis comparing 28 cases of bacteremic community acquired bacterial meningitis (BCBM) to all CBM, no significant risk factor concerning underlying disease (cancer, ENT infection, alcohol abuses, trauma, splenectomy, etc.) or etiology was observed apart of diabetes mellitus, which was more common among bacteremic meningitis (21.4% vs. 7.5%, p=0.02). Mortality (25% vs. 12.4%, NS) insignificantly but therapy failure (32.1% vs. 9.5%, p=0.01) was significantly more frequently observed among meningitis with bacteremia. N. meningitis was the commonest causative agent (8 of 28 cases) followed by Str. pneumoniae (6), gram-negative bacteria (6), S. aureus (4) and H. influenzae (2).


Subject(s)
Bacteremia/complications , Diabetes Complications/microbiology , Meningitis, Bacterial/complications , Bacteremia/therapy , Bacteria/isolation & purification , Community-Acquired Infections/complications , Community-Acquired Infections/microbiology , Community-Acquired Infections/therapy , Diabetes Complications/therapy , Diabetes Mellitus/microbiology , Humans , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/therapy , Outcome Assessment, Health Care , Risk Factors , Treatment Failure
8.
Neuro Endocrinol Lett ; 28 Suppl 3: 30-1, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18030275

ABSTRACT

Despite of 10 years vaccination of all children within 1st year in Slovakia against H. influenzae, this severe infection still occurs. Among 201 cases of community acquired bacterial meningitis, 14 (7%) were caused by H. influenzae serotype B. Outcome however, after early institution of treatment was fortunately positive - only 1 patient died (7.1% mortality) and in 2 other neurologic sequellae occurred (14.3%), which were transient and mild.


Subject(s)
Haemophilus influenzae type b , Immunization Programs , Meningitis, Haemophilus/epidemiology , Child , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/prevention & control , Humans , Infant , Meningitis, Haemophilus/prevention & control , Outcome Assessment, Health Care , Slovakia/epidemiology
11.
Neuro Endocrinol Lett ; 28 Suppl 2: 17-8, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558368

ABSTRACT

We have been unable to document a benefit of a combination of aminoglycosides with betalactam or carbapenem antibiotics in nosocomial meningitis. This was similar to the cases of sepsis, where survival of patients did not improve with combination therapy. Combination therapy did not increase the chance of appropriateness of the therapy. 30% of those on combination therapy were considered as inappropriately treated in comparison to 2.8% of those on monotherapy (p<0.01).


Subject(s)
Aminoglycosides/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cross Infection/drug therapy , Meningitis, Bacterial/drug therapy , beta-Lactams/administration & dosage , Carbapenems/administration & dosage , Child , Child, Preschool , Drug Therapy, Combination , Glycopeptides/administration & dosage , Humans , Infant , Infant, Newborn , Prognosis , Retrospective Studies , Treatment Outcome
13.
Neuro Endocrinol Lett ; 28 Suppl 2: 15-6, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558367

ABSTRACT

Twenty five (25) cases of nosocomial postsurgical meningitis due to Acinetobacter baumannii meningitis were compared to other 146 cases of meningitis after surgery caused by other pathogens. Prior neurosurgical ventriculo-peritoneal shunt insertion and CNS abnormality as well as very low birth weight were significant risk factors for acquisition of Acinetobacter baumannii meningitis. Mortality - 40% among children with nosocomial meningitis was unacceptably high and significantly higher than among meningitis caused by microorganisms other than Acinetobacter baumannii.


Subject(s)
Acinetobacter Infections/mortality , Acinetobacter baumannii/isolation & purification , Cross Infection/microbiology , Meningitis, Bacterial/microbiology , Surgical Wound Infection/microbiology , Acinetobacter Infections/drug therapy , Acinetobacter baumannii/immunology , Anti-Bacterial Agents/therapeutic use , Central Nervous System/abnormalities , Central Nervous System/pathology , Child , Child, Preschool , Cross Infection/drug therapy , Cross Infection/mortality , Humans , Infant, Newborn , Infant, Very Low Birth Weight/immunology , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/mortality , Risk Factors , Surgical Wound Infection/drug therapy , Surgical Wound Infection/mortality , Ventriculoperitoneal Shunt/adverse effects
15.
Neuro Endocrinol Lett ; 28 Suppl 2: 25-6, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558372

ABSTRACT

Within last 25 years we have observed 20 cases of fungal meningitis and/or cerebral abscesses. Commonest etiologic agens was Candida spp. (C. albicans 9 of 20). Molds were responsible for 4 cases of brain abscess. Mortality was 50% what seems to be very high. Extremely high mortality is caused by delayed onset of therapy, severe underlying disease and multiresistant fungal organisms such as Mucorales, Fusarium solani and Aureobasidium.


Subject(s)
Brain Abscess/microbiology , Candidiasis/mortality , Meningitis, Fungal/mortality , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/microbiology , Antifungal Agents/therapeutic use , Brain Abscess/complications , Brain Abscess/drug therapy , Brain Abscess/mortality , Candidiasis/drug therapy , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/mortality , Meningitis, Fungal/complications , Meningitis, Fungal/drug therapy , Meningitis, Fungal/microbiology , Rare Diseases , Retrospective Studies
16.
Neuro Endocrinol Lett ; 28 Suppl 2: 30-1, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558374

ABSTRACT

Streptococcus agalactiae is a rare cause of neonatal meningitis in the era of peripartum prophylaxis with prophylaxis with ampicillin in colonized/infected mothers. However 5 cases of meningitis among 171 cases of pediatric nosocomial meningitis database within last 15 years occurred. All 5 children were neonates (one VLBW and early gestation newborn), 2 after neurosurgery. All 5 cases were successfully cured with a combination of cefotaxim (or ceftazidim) plus aminoglycosides, in one case also with addition of vancomycin or ampicillin. However 3 of 5 cured patients had neurologic sequellae, two of them reversible hydrocephalus and in speech retardation.


Subject(s)
Cross Infection/microbiology , Meningitis, Bacterial/microbiology , Streptococcal Infections/complications , Streptococcus agalactiae/pathogenicity , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Cross Infection/etiology , Humans , Hydrocephalus/etiology , Infant, Newborn , Language Development Disorders/etiology , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/etiology , Rare Diseases , Retrospective Studies , Streptococcal Infections/drug therapy
17.
Neuro Endocrinol Lett ; 28 Suppl 2: 34-5, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558376

ABSTRACT

Analysing 101 cases of nosocomial meningitis due to staphylococci other than S. aureus within last 15 years, coagulase negative staphylococci represented the commonest pathogen. Major risk factor for staphylococcal meningitis was prior neurosurgery, mainly ventriculoperitoneal shunt insertion. Ten of 101 cases were caused by glycopeptide intermediate resistant strains in patients pretreated with multiple combination of antibiotics including vancomycin and shunt exchanges: 76% of strains were also oxacillin resistant.


Subject(s)
Cross Infection/microbiology , Meningitis, Bacterial/microbiology , Postoperative Complications/microbiology , Staphylococcal Infections/complications , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Cross Infection/drug therapy , Cross Infection/etiology , Humans , Infant , Infant, Newborn , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/etiology , Neurosurgical Procedures/adverse effects , Postoperative Complications/drug therapy , Retrospective Studies , Staphylococcaceae/isolation & purification , Staphylococcal Infections/drug therapy , Ventriculoperitoneal Shunt/adverse effects
18.
Neuro Endocrinol Lett ; 28 Suppl 2: 32-3, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558375

ABSTRACT

Enterococcal meningitis is a rare complication of neurosurgical procedure or high technology treatment of children and occurs mainly imunocompromised neonates with very low birth weight, severe prematurity and complicates sometime ventriculoperitoneal shunt insertion or perinatal trauma. E. faecalis caused 10 nosocomial meningitis and all strains were susceptible to vancomycin and chloramphenicol, and in our database 90% also to gentamicin and ampicillin. Mortality in our group of 10 children was 20% what is insignificantly higher than overall mortality in the whole cohort of meningitis within last 15 years in our database (15.1%). Early empiric therapy should include also ampicillin or vancomycin, if enterococcal etiology is suspected.


Subject(s)
Cross Infection/microbiology , Enterococcus faecalis/pathogenicity , Gram-Positive Bacterial Infections/complications , Meningitis, Bacterial/microbiology , Postoperative Complications/microbiology , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Cross Infection/etiology , Gram-Positive Bacterial Infections/drug therapy , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/etiology , Neurosurgical Procedures/adverse effects , Postoperative Complications/drug therapy , Rare Diseases , Retrospective Studies
19.
Neuro Endocrinol Lett ; 28 Suppl 2: 36-7, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558377

ABSTRACT

Meningitis after artificial implants in 60 children, mainly after foreign body infections (FBI) was caused more frequently by coagulase negative staphylococci and Ps. aeruginosa than other organisms and was significantly associated with perinatal trauma, hydrocephalus, haemorrhage or VLBW and had more neurologic sequels despite mortality was similar to other nosocomial meningitis.


Subject(s)
Cerebrospinal Fluid Shunts/adverse effects , Meningitis/complications , Prosthesis-Related Infections/complications , Pseudomonas Infections/complications , Staphylococcal Infections/complications , Brain Injuries/complications , Brain Injuries/microbiology , Brain Injuries/surgery , Child , Child, Preschool , Foreign Bodies/microbiology , Humans , Hydrocephalus/complications , Hydrocephalus/surgery , Infant , Infant, Newborn , Infant, Very Low Birth Weight , Intracranial Hemorrhages/complications , Meningitis/microbiology , Neurosurgical Procedures/adverse effects , Prosthesis-Related Infections/microbiology
20.
Neuro Endocrinol Lett ; 28 Suppl 2: 38-9, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17558378

ABSTRACT

Within last 15 years, analyzing patterns of etiology and resistance in organisms causing neuroinfections, emergence of resistance has been observed in Slovakia in S. haemolyticus to teicoplanin (11%), Ps. aeruginosa and A. baumannii to meropenem (20%) and Candida spp. (non-albicans Candida spp.) to fluconazol (20%). There are no new antibiotics against carbapenem resistant Ps. aeruginosa and Acinetobacter baumannii.


Subject(s)
Anti-Infective Agents/therapeutic use , Cross Infection/drug therapy , Drug Resistance, Microbial , Meningitis/drug therapy , Brain Diseases/drug therapy , Brain Diseases/microbiology , Candidiasis/drug therapy , Cross Infection/microbiology , Fluconazole/therapeutic use , Humans , Meningitis/microbiology , Meropenem , Pseudomonas Infections/drug therapy , Staphylococcal Infections/drug therapy , Teicoplanin/therapeutic use , Thienamycins/therapeutic use
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