The Clinical Features And Outcome Of Community-acquired Bacterial Meningitis

Objective : To get better understanding of bacterial meningitis for clinical practice,the clinical features of community-acquired bacterial meningitis and the factors affecting the prognosis were analysed.Method : By retrospective analysis,the clinical data of 97 patients with community-acquired meningitis from 2011 to 2020 in the First Affiliated Hospital of Chongqing Medical University were collected,to analysed the clinical features and factors affecting prognosis.Result : 1.This study included 97 community-acquired meningitis patients.There were 57 males and 37 females,with a male to female ratio of 1.54:1.2.Headache was the most common symptom(81.91%,77/94 cases),followed by fever(76.60%,72/94 cases),vomiting(59.57%,56/94 cases),etc.3.43.53%(37/85 cases)patients were significantly increased(>2000*106/L)in the total number of white blood cells in the cerebrospinal fluid(CSF).30.34%(27/89 cases)of patients had a CSF glucose concentration lower than 1.9 mmol/L.31.65%(25/79 cases)of patients had a significant decrease(<0.23)in the blood/CSF glucose ratio.4.Only 37.11%(36/97 cases)of patients obtained pathogen evidence.Listeria monocytogenes(27.78%,10/36 cases)is the most common pathogen.Followed by Streptococcus pneumoniae(25.00%,9/36 cases)and Klebsiella pneumoniae(11.11%,4/36 cases).5.Compared with Streptococcus pneumoniae,The total number of white blood cells(13.21*109/L Vs 20.63*109/L,P<0.01),the percentage of neutrophils(83.25% Vs 93.20%,P<0.01),the proportion of multinucleated cells in the CSF(64.50% vs 90.00%,P<0.001),and the protein in the CSF(3.20g/L vs 6.16g/L,P<0.05)in Listeria monocytogenes meningitis patients were all lower.The total number of blood lymphocytes(1.10*109/L Vs0.57*109/L,P<0.05)and the proportion of CSF mononuclear cells(30.50%Vs 10.00%,P<0.05)were higher than those in Streptococcus pneumoniae meningitis patients.6.The univariate analysis of the prognosis indicated that patients in the poor prognosis group were older(60 years old vs 49 years old,P<0.01)and total serum protein(65.95g/L vs 69.46g/L,P<0.05),albumin(34.00g/L Vs40.00g/L,P<0.01)were lower,aspartate aminotransferase(AST)(36.0U/L Vs 28.0U/L,P<0.01)was higher.Multivariate analysis of the prognosis suggested that age(OR: 0.961,CI: 0.930-0.994,P<0.05)and AST(OR:0.974,CI: 0.953-0.996,P<0.05)were risk factors for poor prognosis.7.Compared with non-elderly patients,elderly patients’ serum albumin(33.00g/L Vs 40.00g/L,P< 0.001),the number of multinucleated cells in the CSF(201.00*106/L vs 1121.00*106/L,P<0.05)and CSF glucose(2.00mmol/L vs 2.70mmol/L,P<0.05)were lower,and CSF protein(4.02g/L Vs 1.74g/L,P<0.05)were higher.Conclusion:1.It was more difficult to diagnosed and treat bacterial meningitis earlier in southwestern China,because of non-specific clinical manifestations,atypical CSF characteristics,and a low proportion of pathogen-proved patients.2.The most common pathogen is Listeria monocytogenes,which was significantly different from Streptococcus pneumoniae in blood and CSF characteristics.3.Through univariate and multivariate analysis of the patient’s prognosis,it was found that elderly,decreased serum albumin,and increased serum AST were related to the poor prognosis of patients.Compared with non-elderly patients,elderly patients were generally worse and have heavier neurology inflammation.