Praćenje izmena etiologije i kliničke prezentacije bakterijskih meningitisa u cilju definisanja racionalnog dijagnostičkog i terapijskog pristupa

Abstract

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.