Abstract
BackgroundCentral nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections.MethodsA retrospective study was conducted with patients with positive cerebrospinal fluid (CSF) cultures in a teaching hospital from January 2012 to December 2019. The following data were collected: demographic characteristics, laboratory data, causative organisms and antimicrobial sensitivity results. Data were analyzed with SPSS 16.0. Univariate analysis and binary logistic regression analyses were performed to identify the risk factors for mortality and MDR bacterial infections.ResultsA total of 72 patients were diagnosed with CNS infections, and 86 isolates were identified. The proportions of Gram-positive bacteria, Gram-negative bacteria and fungi were 59.3, 30.2 and 10.5%, respectively. The predominant Gram-positive bacteria was Coagulase-negative Staphylococci. Acinetobacter baumannii, Escherichia coli and Klebsiella spp. were the predominant Gram-negative bacteria. Compared to 2012–2015 years, the proportion of Gram-negative bacteria increased markedly during 2016–2019 years. Coagulase-negative Staphylococci, Streptococcus pneumoniae and Enterococcus faecium had 100% sensitivity to vancomycin, teicoplanin and linezolid. Acinetobacter baumannii and Klebsiella pneumoniae were 100% sensitive to tigecycline. Escherichia coli had 100% sensitivity to amikacin, meropenem and imipenem. The overall mortality rate in the 72 patients was 30.6%. In multivariate analysis, age > 50 years, pulmonary infections and CSF glucose level < the normal value were associated with poor outcomes. CSF adenosine deaminase level > the normal value and the presence of external ventricular drainage/lumbar cistern drainage were associated with MDR bacterial infections.ConclusionsThe mortality rate due to CNS infections reached 30.6% in our study. The proportion of Gram-negative bacteria has increased markedly in recent years. We should give particular attention to patients with risk factors for mortality and MDR bacterial infections mentioned above.
Highlights
Central nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide
The third set of records included the following laboratory test results: the glucose level, protein level, chlorine level, adenosine deaminase (ADA) level, leukocyte count and erythrocyte count in the Cerebrospinal fluid (CSF); the white blood cell count, neutrophil count and percentage of neutrophils in the blood; the levels of liver function indicators, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), alkaline phosphatase (ALP), total protein and albumin; and the levels of renal function indicators, including creatinine and urea nitrogen
Study population From January 2012 to December 2019, we obtained 111 positive CSF culture samples from 98 patients; 22 patients were excluded because they did not meet the diagnostic criteria for a CNS infections
Summary
Central nervous system (CNS) infections are relatively rare but are associated with high mortality worldwide. Empirical antimicrobial therapy is crucial for the survival of patients with CNS infections, and should be based on the knowledge of the pathogen distribution and antibiotic sensitivities. The aim of this study was to investigate the features of pathogens in patients with CNS infections in North China and evaluate the risk factors for mortality and multi-drug-resistant (MDR) bacterial infections. More than 100 pathogens have been reported to cause CNS infections, including bacteria, viruses, fungi and parasites [5]. Empirical antimicrobial therapy is essential while the pathogen identification and antimicrobial susceptibility test results are still pending, and should be based on the knowledge of the prevalence of various bacterial organisms and their antibiotic sensitivity. The prevalence of pathogens causing bacterial infections varies based on time, geographical distribution and underlying medical conditions [13]. The availability of local bacterial prevalence and antibiotic sensitivity data could help improve the empirical administration of antimicrobial therapy
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