Hospital-Based Study of the Prognostic Factors in Adult Patients with Acute Community-Acquired Bacterial Meningitis in Tokyo, Japan
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概要
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Background Prognostic factors related to community-acquired bacterial meningitis (BM) in adult patients have been evaluated using multivariate analysis in the Netherlands, where the rate of antibiotic resistance was low. However, an evaluation of these factors in countries with a high rate of antibiotic resistance has not yet been done. Thus, we studied the prognostic factors in adults with community-acquired BM in our hospitals, which are located in Tokyo, Japan, where the rate of antibiotic resistance is high. Methods We selected 71 consecutive adult patients with community-acquired BM in which the pathogens were identified and then classified the patients into two groups based on the Glasgow Outcome Scale: a favorable outcome group (n=48), and an unfavorable outcome group (n=23). Their clinical and laboratory variables were analyzed using single logistic regression analysis followed by multiple logistic regression analysis. Results The overall mortality rate was 23%. The rate of antibiotic resistance was 54.9%. The most common resistant bacteria were penicillin-resistant Streptococcus pneumoniae, followed by methicillin-resistant Staphylococcus aureus. The Glasgow Coma Scale score (GCS) at the initiation of antibiotic therapy and a low thrombocyte count were identified as significant unfavorable prognostic factors (GCS: p=0.020, odds ratio=0.528, 95%CI=0.309-0.902; thrombocyte count: p=0.037, odds ratio=0.802, 95%CI=0.652-0.987). The presence of antibiotic-resistant bacteria was not identified as a prognostic factor. Conclusion Patients with a low GCS at the initiation of antibiotic therapy and low thrombocyte counts had unfavorable outcomes. With appropriate antibiotic administration, the antibiotic-resistant bacteria were not identified as an unfavorable prognostic factor, even in an area with a high rate of antibiotic resistance.
著者
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Morita Akihiko
Division Of Neurology Department Of Medicine Nihon University School Of Medicine
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Mizutani Tomohiko
Division Of Neurology Department Of Medicine Nihon University School Of Medicine
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Naganuma Tomoka
Division Of Applied System Neuroscience Advanced Medical Research Center Nihon University Graduate S
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Minami Masayuki
Division Of Neurology Department Of Medicine Nihon University School Of Medicine
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Kamei Satoshi
Division Of Neurology Department Of Medicine Nihon University School Of Medicine
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Ishihara Masaki
Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, Japan
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Miki Kenji
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine
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Taira Naoto
Division of Neurology, Department of Medicine, Nihon University School of Medicine
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Hara Motohiko
Division of Neurology, Department of Medicine, Nihon University School of Medicine
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Shiota Hiroshi
Division of Neurology, Department of Medicine, Nihon University School of Medicine
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Naganuma Tomoka
Division of Neurology, Department of Medicine, Nihon University School of Medicine
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