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題名 | Pseudomonas Aeruginosa Central Nervous System Infections: Analysis of Clinical Features of 16 Adult Patients=中樞神經系統之綠膿桿菌感染:16位成人病例臨床表現的分析 |
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作者 | 莊曜聰; 張文能; 盧成憲; 吳秀善; 張學文; | 書刊名 | 中華醫學雜誌 |
卷期 | 62:5 1999.05[民88.05] |
頁次 | 頁300-307 |
分類號 | 415.823 |
關鍵詞 | 腦膿瘍; 中樞神經系統感染; 脊髓硬膜外膿瘍; 腦膜炎; 綠膿桿菌; 預後因子; Brain abscess; Central nervous system infection; Epidural abscess; Meningitis; Prognostic factors; Pseudomonas aeruginosa; |
語文 | 英文(English) |
中文摘要 | 背景:分析16位成年病人因綠膿桿菌(Pseudomonas aeruginosa)所引起之中樞 神經系統感染的臨床表現及治療結果,並且找出影響此一可能致死疾病有意義之預後因子。 方法:此回溯性研究包括16位中樞神經系統綠膿桿菌感染之病例,分別有9位男性及7位女 性,其年齡為18.86歲。此外,藉由統計分析來找出有意義之預後因子。 結果:16位病患中有13位腦膜炎與3位局部化膿症(2位腦膿瘍和1位脊髓硬膜外膿瘍)。而 13例腦膜炎可分為2種形式:自發式(spontaneous form)及神經外科相關式( neurosurgical form)。易患此病的因素包括頭部外傷併顱骨骨折、經神經外科處置、免 疫機能抑制和長期的身心耗弱疾病。而那位脊髓硬膜外膿瘍的病人則因下背痛接受針灸治 療而感染。病人的總死亡率為37.5%,其中在腦膜炎病人群中,神經外科相關式比自發式 有較低之死亡率(11.1%對1OO%),社區感染比院內感染有較高之死亡率(80%對12.3%) 。社區感染預後較差是因為嚴重的疾病、中樞神經系統缺乏對綠膿桿菌感染之警覺以及不 適當抗生素之選擇。除1位病患因手術併發症死亡外,其餘局部化膿症的病患在接受外科 手術治療後均存活。但所有未接受適當抗生素治療的病患全部死亡。統計上有意義的預後 因子包括:獲得感染的方式、感染的形式、菌血症、開始發病時之意識狀態及適當抗生素 之應用。 結論:成年人因綠膿桿菌所引起之中樞神經系統感染易發現在處於醫院環境內之頭部外傷 、經神經外科處置、免疫機能抑制和患長期身心耗弱疾病的病人。早期適當應用抗生素和 對局部性化膿症病患施行神經外科處置是非常重要的,因這樣能確保較好的治療結果。 |
英文摘要 | Background. The purpose of this study was to analyze the clinical features and therapeutic outcome of 16 adult patients with Pseudomonas aeruginosa central nervous system (CNS) infection. We also attempted to identify the factors that significantly influence the prognosis of this potentially fatal CNS infection. Methods. Sixteen adult patients with P aeruginosa CNS infection, nine men and seven women, aged from 18 to 86 years, were included in this retrospective study. The clinical features and the laboratory data of these patients were analyzed. Potential prognostic factors were compared by means of Fisher's exact test and the relative risks were estimated by odds ratio. Results. Of the 16 patients, 13 had meningitis and three had f-6cal suppuration (two with brain abscess and one with spinal epidural abscess). The 13 meningitis patients with nosocomial or community-acquired infections were classified into two forms: the spon-taneous form and the neurosurgical form. The overall mortality rate was 37.5 % (6/16). In the meningitis group, the patients with the neurosurgical form had a lower mortality rate (11.1 %; 1/ 9) than the patients with the spontaneous form (100 %; 4/4), and those with community-acquired meningitis had a higher mortality rate (80%; 4/5) than those with nosocomial infections (12.5%; 1/8). All the meningitis patients who did not receive appropriate antibiotic treatment expired. The statistically significant prognostic factors included the acquisition of infection, form of infection, bacteremia, initial level of consciousness and the use of appropriate antibiotics. Conclusions. Vigilance for P aeruginosa is particularly important in patients with pre-disposing factors such as head injury, neurosurgical procedures and long-term debilitating diseases. Early appropriate antibiotic therapy and neurosurgical intervention for patients with suppurative infections can bring about improved therapeutic results. |
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