RESUMEN
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).
Asunto(s)
Alcoholismo/complicaciones , Daño Encefálico Crónico/etiología , Lesiones Encefálicas/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Meningitis Bacterianas/terapia , Alcoholismo/mortalidad , Lesiones Encefálicas/mortalidad , Distribución de Chi-Cuadrado , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/terapia , Diabetes Mellitus , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Gramnegativas/terapia , Humanos , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/mortalidad , Factores de Riesgo , Eslovaquia , Insuficiencia del TratamientoRESUMEN
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).
Asunto(s)
Infección Hospitalaria/mortalidad , Meningitis Bacterianas/mortalidad , Complicaciones Posoperatorias/mortalidad , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infección Hospitalaria/complicaciones , Infección Hospitalaria/microbiología , Humanos , Meningitis Bacterianas/etiología , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/terapia , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/microbiología , Factores de Riesgo , Eslovaquia/epidemiología , Estadísticas no Paramétricas , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Trastornos Relacionados con Alcohol/complicaciones , Traumatismos Craneocerebrales/complicaciones , Meningitis Bacterianas/etiología , Antibacterianos/uso terapéutico , Bacterias/clasificación , Bacterias/patogenicidad , Daño Encefálico Crónico/etiología , Daño Encefálico Crónico/prevención & control , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/etiología , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/terapia , Humanos , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/mortalidad , Meningitis Bacterianas/terapia , Evaluación de Resultado en la Atención de Salud , Factores de RiesgoRESUMEN
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).
Asunto(s)
Meningitis Bacterianas/etiología , Otitis Media/complicaciones , Sinusitis/complicaciones , Trastornos Relacionados con Alcohol/complicaciones , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/etiología , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/terapia , Complicaciones de la Diabetes , Humanos , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/mortalidad , Meningitis Bacterianas/terapia , Otitis Media/microbiología , Evaluación de Resultado en la Atención de Salud , Factores de Riesgo , Sinusitis/microbiología , Heridas y Lesiones/complicacionesRESUMEN
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.
Asunto(s)
Ampicilina/uso terapéutico , Antibacterianos/uso terapéutico , Listeriosis/microbiología , Meningitis Bacterianas/microbiología , Adulto , Anciano , Cefotaxima/uso terapéutico , Farmacorresistencia Bacteriana , Femenino , Humanos , Listeriosis/tratamiento farmacológico , Listeriosis/mortalidad , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/mortalidad , Persona de Mediana Edad , Evaluación de Resultado en la Atención de SaludRESUMEN
Etiology and risk factors such as malnutrition, diabetes, otitis/sinusitis, alcohol abuse, tuberculosis, low birth weigh as well as mortality and neurologic sequellea in Roma ethnic minority with community acquired bacterial meningitis (CBM) was assessed and compared to all CBM cases.
Asunto(s)
Desnutrición/complicaciones , Meningitis Bacterianas/etnología , Romaní/estadística & datos numéricos , Factores de Edad , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/terapia , Humanos , Recién Nacido , Desnutrición/etnología , Meningitis Bacterianas/mortalidad , Meningitis Bacterianas/terapia , Evaluación de Resultado en la Atención de Salud , Factores de Riesgo , Eslovaquia/epidemiología , Estadísticas no ParamétricasRESUMEN
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).
Asunto(s)
Bacteriemia/complicaciones , Complicaciones de la Diabetes/microbiología , Meningitis Bacterianas/complicaciones , Bacteriemia/terapia , Bacterias/aislamiento & purificación , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/terapia , Complicaciones de la Diabetes/terapia , Diabetes Mellitus/microbiología , Humanos , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/terapia , Evaluación de Resultado en la Atención de Salud , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
Case report l4-year-old girl with bacterial meningitis. Neuroinfection started after late-treated vestibular inflammation, caused by Streptococcus pneumoniae. Clinical manifestation was complicated with thrombosis of arteria carotis interna in the left side. Neurologic topic symptomatology fell back. It was due by transformed communications by arteria communicans anterior from opposite site.
Asunto(s)
Trombosis de las Arterias Carótidas/complicaciones , Meningitis Neumocócica/complicaciones , Adolescente , Arteria Carótida Interna , Femenino , HumanosRESUMEN
Risk factors, mortality and antimicrobial susceptibility of Pseudomonas aeruginosa bacteremias isolated from 148 patients from all University Hospitals in Slovakia were analyzed. Only 1.2% of 169 strains of P. aeruginosa were resistant to meropenem, 4.1% to piperacillin/tazobactam, 7.7% to ceftazidime as well as cefepime and 12% to amikacin. More than 30% of P. aeruginosa were resistant to ciprofloxacin. Our analysis of risk factors for antimicrobial resistance to the particular antimicrobials, indicated no difference in risk factors and outcome in cases infected with P. aeruginosa bacteremias resistant to amikacin, piperacillin/tazobactam or ceftazidime in comparison to episodes caused by P. aeruginosa due to susceptible isolates. When comparing risk factors for P. aeruginosa bacteremia in children vs. adults, cancer vs. non-cancer patients, several differences in risk factors were observed. Neither antimicrobial resistance to amikacin, ceftazidime or piperacillin/tazobactam, nor appropriateness of therapy according to two separate analyses were associated with better outcome.
Asunto(s)
Antibacterianos/farmacología , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/patogenicidad , Adulto , Factores de Edad , Bacteriemia , Niño , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/aislamiento & purificación , Estudios Retrospectivos , Factores de Riesgo , Eslovaquia/epidemiologíaRESUMEN
BACKGROUND: Neuroborreliosis affects peripheral and central nervous system. OBJECTIVES: Point out on possibilities of laboratory diagnostics of neuroborreliosis. SUBJECTS AND METHODS: During 1997-2001 we tested 666 pair samples of CSF and serum from 661 patients with different neurological diagnosis by ELISA, Westernblot, PCR, completed by biochemical and cytological investigations. RESULTS: We confirmed intrathecal specific IgG antibodies production by AI in 14 cases (2.1%) of total 666 samples tested. From those in 7 cases there were present also IgM antibodies in CSF. We found borderline AI values in 3 cases (0.5%) and isolated intrathecal production, antibodies present only in CSF, in 1 case (0.15%). There were normal AI values found in 25 cases (3.8%). Specific antibody possitivity by WB method was detected only in one case. DNA positivity by PCR was detected in one CSF from 43 samples during 2 years period. CONCLUSIONS: The microbiological test results should not be used in isolation but used in correlation with the biochemical and cytologic tests and also with clinical symptoms and epidemiological data to produce an overall clinical diagnosis. (Tab. 7, Fig. 1, Ref. 21)