RESUMO
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).
Assuntos
Alcoolismo/complicações , Dano Encefálico Crônico/etiologia , Lesões Encefálicas/complicações , Infecções por Bactérias Gram-Negativas/complicações , Meningites Bacterianas/terapia , Alcoolismo/mortalidade , Lesões Encefálicas/mortalidade , Distribuição de Qui-Quadrado , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Diabetes Mellitus , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Meningites Bacterianas/complicações , Meningites Bacterianas/mortalidade , Fatores de Risco , Eslováquia , Falha de TratamentoRESUMO
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).
Assuntos
Infecção Hospitalar/mortalidade , Meningites Bacterianas/mortalidade , Complicações Pós-Operatórias/mortalidade , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Humanos , Meningites Bacterianas/etiologia , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/microbiologia , Fatores de Risco , Eslováquia/epidemiologia , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do TratamentoRESUMO
Pregnancy presents special medical problem where we need to take into account travel risks regarding pregnant women and the health limits as a consequence of pregnancy. It is also important to consider the fact that active prevention and treatment approaches are to a large degree limited by the pregnancy. The most optimal period for travelling is the second trimester. In most cases, the potential risk of administering the vaccine is theoretical and not based on clinical evidence. Pregnancy presents a special problem regarding many aspects of immunization: benefit of vaccination, potential disease risk to the mother and fetus and safety of vaccine to mother and fetus itself. In general, pregnant patients should avoid live vaccines. Vaccination with inactivated, conjugated, polysacahecride vaccines and toxoids is possible. The first trimester of pregnancy is the most vulnerable period because of theoretical risk of harmful effects to the fetus.
Assuntos
Complicações Infecciosas na Gravidez/prevenção & controle , Viagem , Vacinação , Feminino , Humanos , Gravidez , Vacinação/efeitos adversosRESUMO
Economy class syndrome is the term for cases of venous thrombosis/, that start in connection with travelling for long distance. Syndrome occurs most frequently in economy class of flying. Because of crowded uncomfortable conditions by sitting, without movement during longer journey by plane can cause thrombosis, especially for patients with risk factors. Sequentially thrombembolism can occur. The most often risk factors are age, obesity, hormonal contraception, previous thrombosis in case history, smoking, immobilization, diabetes mellitus, diseases of vascular system and kidneys, and others.