RESUMO
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.
Assuntos
Desnutrição/complicações , Meningites Bacterianas/etnologia , Roma (Grupo Étnico)/estatística & dados numéricos , Fatores Etários , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Humanos , Recém-Nascido , Desnutrição/etnologia , Meningites Bacterianas/mortalidade , Meningites Bacterianas/terapia , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Eslováquia/epidemiologia , Estatísticas não ParamétricasRESUMO
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).
Assuntos
Bacteriemia/complicações , Complicações do Diabetes/microbiologia , Meningites Bacterianas/complicações , Bacteriemia/terapia , Bactérias/isolamento & purificação , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus/microbiologia , Humanos , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Falha de TratamentoRESUMO
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).
Assuntos
Traumatismos Craniocerebrais/complicações , Meningite Pneumocócica/complicações , Meningite/complicações , Transtornos Relacionados ao Uso de Álcool/complicações , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/terapia , Humanos , Macrolídeos/uso terapêutico , Meningite/terapia , Meningite Pneumocócica/terapia , Avaliação de Resultados em Cuidados de Saúde , Penicilinas/uso terapêutico , Fatores de RiscoRESUMO
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.
Assuntos
Infecção Hospitalar/microbiologia , Infecções por Bactérias Gram-Negativas/complicações , Meningites Bacterianas/complicações , Distribuição de Qui-Quadrado , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Bactérias Gram-Negativas/classificação , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Recém-Nascido , Meningites Bacterianas/microbiologia , Meningites Bacterianas/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Doenças Raras , Fatores de RiscoRESUMO
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.
Assuntos
Haemophilus influenzae tipo b , Programas de Imunização , Meningite por Haemophilus/epidemiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Humanos , Lactente , Meningite por Haemophilus/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Eslováquia/epidemiologiaRESUMO
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).
Assuntos
Meningites Bacterianas/etiologia , Otite Média/complicações , Sinusite/complicações , Transtornos Relacionados ao Uso de Álcool/complicações , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Complicações do Diabetes , Humanos , Meningites Bacterianas/microbiologia , Meningites Bacterianas/mortalidade , Meningites Bacterianas/terapia , Otite Média/microbiologia , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Sinusite/microbiologia , Ferimentos e Lesões/complicaçõesRESUMO
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).