Spontaneous gram-negative bacillary meningitis in adult patients: characteristics and outcome

被引:44
作者
Pomar, Virginia [1 ]
Benito, Natividad [1 ]
Lopez-Contreras, Joaquin [1 ]
Coll, Pere [2 ]
Gurgui, Mercedes [1 ]
Domingo, Pere [1 ]
机构
[1] Univ Autonoma Barcelona, Dept Internal Med, Infect Dis Unit,Spanish Network Res Infect Dis RE, Hosp Santa Creu & St Pau,Inst Invest Biomed St Pa, Barcelona 08025, Catalonia, Spain
[2] Univ Autonoma Barcelona, Spanish Network Res Infect Dis REIPI, Dept Clin Microbiol, Hosp Santa Creu & St Pau,Inst Invest Biomed St Pa, Barcelona 08025, Catalonia, Spain
来源
BMC INFECTIOUS DISEASES | 2013年 / 13卷
关键词
ACUTE BACTERIAL-MENINGITIS; PROGNOSTIC-FACTORS; RESISTANCE; LISTERIA; RISK;
D O I
10.1186/1471-2334-13-451
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Spontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens. Methods: Prospective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outcome Measure: In-hospital mortality. Results: Gram-negative bacilli meningitis was diagnosed in 40 (7%) of 544 episodes of spontaneous acute bacterial meningitis. The most common pathogens were Escherichia coli and Pseudomonas species. On admission, characteristics associated with spontaneous gram-negative bacilli meningitis by multivariate modeling were advanced age, history of cancer, nosocomial acquisition of infection, urinary tract infection as distant focus of infection, absence of rash, hypotension, and a high cerebrospinal fluid white-cell count. Nine (23%) episodes were acquired in the hospital and they were most commonly caused by Pseudomonas. The in-hospital mortality rate was 53%. The mortality rate was higher among patients with Gram-negative bacillary meningitis than among those with other bacterial meningitis and their risk of death was twenty times higher than among patients infected with Neisseria meningitidis (odds ratio 20.47; 95% confidence interval 4.03-103.93; p<0.001). Conclusions: Gram-negative bacilli cause 9% of spontaneous bacterial meningitis of known etiology in adults. Characteristics associated with GNBM include advanced age, history of cancer, nosocomial acquisition, and urinary tract infection as distant focus of infection. The mortality rate is higher among patients with gram-negative bacillary meningitis than among those with other bacterial meningitides.
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页数:9
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