Objective To analyze the clinical characteristics and prognosis of pathogenic positive bacterial meningitis(BM)in adult patients retrospectively at the First Affiliated Hospital of Nanjing Medical University.Methods The clinical data of BM patients with positive cerebrospinal fluid culture treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2022 were collected,including patient age,gender,underlying disease,clinical manifestation,pathogen distribution,and laboratory tests.The patients were assigned to death group or survivor groupaccording to the outcome.Chi-square test was used for univariate analysis.All significant variables related to mortality(P＜0.05)in univariate analysis were included in multivariate analysis by logistic binary regression.Results Among the 121 cases of bacterial meningitis,103(85.1％)were hospital acquired,and 18(14.9％)were community acquired.The median age of the patients was 51(41,64)years old,and 70.2％of the patients were male.Fever was the most common symptom(79.3％),followed by consciousness disorder(71.9％)and neck stiffness(47.1％).Listeria monocytogenes was the most common bacteria(5 strains,27.8％)of community acquired BM,followed by Streptococcus pneumoniae(3 strains,16.7％).Acinetobacter baumannii was the most common pathogen of hospital acquired BM(33 strains,30.6％),followed by Klebsiella pneumoniae(19 strains,18.4％),and Pseudomonas aeruginosa(8 strains,7.8％).Overall,10.0％,30.0％and 30.0％of K.pneumoniae isolates were susceptible to ceftriaxone,cefepime and meropenem,respectively,while 14.7％of A.baumannii isolates were susceptible to meropenem.Among the 121 patients with BM,43 patients died.The all-cause mortality rate was 35.5％.Multivariate analysis showed that consciousness disorder(OR 5.332,95％CI:1.034-27.504,P=0.046),CRE infection(OR 18.749,95％CI:1.366-257.329,P=0.028),and central nervous system complications(OR 26.368,95％CI:5.095-136.476,P＜0.001)were independent risk factors for poor outcome of BM patients.Conclusions The bacterial pathogens isolated from hospital acquired BM were more resistant to antimicrobial agents.Consciousness disorder,CRE infection and central nervous system complications are independent risk factors for poor outcome of BM patients.Attention should be paid to the patients with these risk factors in clinical practice.Early and effective antibacterial treatment should be given to patients with CRE infection to improve prognosis.
维普
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