Characteristics of the pathogens in cerebrospinal fluid and prognosis of the adult patients with central venous system infection_Chinese Journal of Evidence-Based Medicine

Authors：

HE Chao , WANG Yuanfang , DAI Zhongqiu , CHEN Zhixing ,  KANG Mei

Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

KANG Mei, Email: kangmei@sina.com

Keywords：

Central venous system infection; Pathogen; Resistance; Mortality

DOI：

10.7507/1672-2531.201612093

Video：

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Objective To investigate the characteristics of the pathogens isolated from the cerebrospinal fluid (CSF) and the prognosis of the adult patients with central venous system (CNS) infection, and to provide the basis for disease treatment. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to West China Hospital of Sichuan University from January 2014 to September 2016, and suffered from CNS infection with the positive results of CSF culture, were retrospectively analyzed. The species distribution and in-vitro susceptibility of the pathogens and hospital mortality were analyzed. Results A total of 157 cases, involving 87 (55.4%) community-acquired cases and 70 (44.6%) hospital-acquired cases, were included. One hundred and fifty-eight strains of the pathogens were isolated from the CSF specimens of these patients, including 73 isolates (46.2%) of gram negative bacteria, 64 isolates (40.5%) of fungus, and 21 isolates (13.3%) of gram positive bacteria. In terms of species distribution,Cryptococcus neoformans was the predominant (62/87, 71.3%) species isolated from the patient with community-acquired infection, whileAcinetobacter calcoaceticus-A. baumannii complex (31/71, 43.7%) was the predominant specie from the patients with hospital-acquired infection. Analysis of the resistance phenotypes showed that all theC. neoformans isolates were susceptible to the antifungal agents. More than 90% ofA. calcoaceticus- A. Baumannii complex isolates were resistant to the regular antibiotics. The resistant rates ofK. pneumoniae isolates to the regular antibiotics were no more than 25%. The hospital mortality of the groups infected by gram-negative bacteria, fungi, and gram-positive bacteria were 52.3% (38/72), 32.8% (21/64), and 19.0% (4/21), respectively. There was statistical difference for the hospital mortality among these groups (P=0.006). Conclusion In our hospital,C. neoformans are the common species isolated from CSF of the patients with community-acquired CNS infection. Gram negative bacilli are commonly isolated from CSF of the hospital-acquired cases. The mortality of patients with gram negative bacilli is high.

Citation： HEChao, WANGYuanfang, DAIZhongqiu, CHENZhixing, KANGMei. Characteristics of the pathogens in cerebrospinal fluid and prognosis of the adult patients with central venous system infection. Chinese Journal of Evidence-Based Medicine, 2017, 17(2): 131-134. doi: 10.7507/1672-2531.201612093 Copy

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1. ?Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
2. Britz E, Perovic O, von Mollendorf C,et al. The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012. PLoS One, 2016, 11(9): e0163036.
3. Castelblanco RL, Lee M, Hasbun R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. Lancet Infect Dis, 2014, 14(9): 813-819.
4. Saraiva M, Santos EC, Saraceni V,et al. Epidemiology of infectious meningitis in the State of Amazonas, Brazil. Rev Soc Bras Med Trop, 2015, 48(Suppl 1): 79-86.
5. Gounder PP, Zulz T, Desai S,et al. Epidemiology of bacterial meningitis in the North American Arctic, 2000-2010. J Infect, 2015, 71(2): 179-187.
6. Tunkel AR, Hartman BJ, Kaplan SL,et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis, 2004, 39(9): 1267-1284.
7. Baron EJ, Miller JM, Weinstein MP,et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis, 2013, 57(4): e22-e121.
8. 申學明, 王序, 高安舉, 等. 顱內感染患者病原菌分布與耐藥性監測. 中華醫院感染學雜志, 2016, 26(3): 3.
9. Sloan DJ, Parris V. Cryptococcal meningitis: epidemiology and therapeutic options. Clin Epidemiol, 2014, 6: 169-182.
10. Hiesgen J, Schutte C, Olorunju S,et al. Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors - A retrospective cohort study. Int J STD AIDS, 2016, DOI: 10.1177/0956462416653559.
11. Fernandes D, Goncalves-Pereira J, Janeiro S,et al. Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: retrospective study. J Crit Care, 2014, 29(3): 347-350.
12. Wall EC, Cartwright K, Scarborough M,et al. High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. PLoS One, 2013, 8(7): e69783.
13. Adriani KS, Brouwer MC, van de Beek D. Risk factors for community-acquired bacterial meningitis in adults. Neth J Med, 2015, 73(2): 53-60.
14. Viale P, Scudeller L, Pea F,et al. Implementation of a Meningitis Care Bundle in the Emergency Room Reduces Mortality Associated With Acute Bacterial Meningitis. Ann Pharmacother, 2015, 49(9): 978-985.

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Characteristics of the pathogens in cerebrospinal fluid and prognosis of the adult patients with central venous system infection

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