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 FailureABSTRACT
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 OutcomeABSTRACT
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 FactorsABSTRACT
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/complicationsABSTRACT
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 FactorsABSTRACT
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 FactorsABSTRACT
Listeria monocytogenes is not a rare pathogen causing meningitis, mainly in small children and in close contacts to livestock. The pathogen is naturally resistant to cephalosporins and some glycopeptides as well, therefore despite of syndromologic diagnosis of meningitis and initial therapy with 3rd generation cephalosporins according to the guidelines therapeutic failures with clinical consequences may occur.
Subject(s)
Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Listeriosis/microbiology , Meningitis, Bacterial/microbiology , Adult , Aged , Cefotaxime/therapeutic use , Drug Resistance, Bacterial , Female , Humans , Listeriosis/drug therapy , Listeriosis/mortality , Male , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/mortality , Middle Aged , Outcome Assessment, Health CareABSTRACT
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 FailureABSTRACT
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.