Praćenje izmena etiologije i kliničke prezentacije bakterijskih meningitisa u cilju definisanja racionalnog dijagnostičkog i terapijskog pristupa
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Infections of the central nervous system are among the most dramatic
conditions in medicine in terms of clinical presentation, possible
consequences, diagnostic difficulties, as well as complexity of
treatment. This problem is increased by the necessity for early
identification of disease. Nowadays, considering the application of
new antibiotics and treatment in intensive care units, 30% mortality
and up to 20% frequency of severe neurological sequelae of bacterial
meningitis are a consequence of belated antimicrobial treatment
caused by unspecific clinical picture or absence of recognizable
cerebrospinal fluid findings. A prospective study included 54 patients
diagnosed with bacterial meningitis and treated at the Clinic for
Infectious Diseases of the Clinical Center in Nis. The diagnosis of
bacterial meningitis was established in 48 (88.9%) patients while two
patients (3.7%) were diagnosed with TBC meningitis, meningitis
bacterialis otogenes and meningitis non specifica (NOS). In 32
...(59.3%) patients the bacteriological examination of the cerebrospinal
fluid was negative, 6 (11.1%) had klebsiella, 4 (7.4%) had
pneumococcal and staphylococcal disease, whereas 2 patients had
Gram positive bacteria, pseudomonas, listeria monocytogenes and
meningococci. A change in etiological agents was evident as the most
frequent cause was klebsiella and multi-resistant microorganisms
pseudomonas and staphylococci were also present. Patients with
hypothermia on admission had 10 times more risk of fatal outcome
(HR=1.692, p=0.027). The participant with glycorrhachia ≤1.20
mmol/l had higher mortality percentage, while the group with values
above 3.05 mmol/l had no fatal outcomes. It was also determined that
survival was significantly shorter if spinal fluid protein concentration
was above 1.2 g/l. Early treatment in accordance with the guidelines
is recommended and it should include third generation cephalosporins
taking into consideration patent’s age and information about chronic
otitis, sinusitis, skull trauma or neurological interventions because
these can point to the expected or nonexpected cause.