VIÊM MÀNG NÃO MỦ DO TRỰC KHUẨN GRAM ÂM MẮC PHẢI CỘNG ĐỒNG TẠI BỆNH VIỆN BỆNH NHIỆT ĐỚI

Abstract

Background: In the past decade, there was an emergence of spontaneous Gram-negative bacilli bacterial meningitis (SGNBM), leading to negative impact on prognosis and mortality. Aging and/or underlying conditions were at increased risk for this illness.

Methods: A case series study of SGNBM was conducted at the Hospital for Tropical Diseases, in Ho Chi Minh City, Vietnamfrom 2014 to 2020.

Results: A total of 68 patients were recruited in our study from January 2014 to June 2020. Typical characteristics of patients were male sex (72.1%), middleage and farmer (54.4%). The most common underlying condition was diabetes mellitus (41.2%). Notably, long-term corticosteroid andco-infection with Strongyloides stercoralis were also common in these patientswith 21/68 (30.9%) and 20/56 (35.7%) cases, respectively. Among patients whose CSF were tested with real-time PCR Strongyloides stercoralis, we found parasite’s existence in 3 cases. Escherichia coli and Klebsiella pneumoniae were the most causative pathogens of SGNBM, accounting for 42.5% (29/68) and 32,3% (22/68) of all cases, respectively. Furthermore, ESBL-producing E. Colis trains accounted for 75.9% (22/29) of all E. Coli meningitis cases. Hence, Ceftriaxone, which is the first-choice antibiotic in community-acquired meningitis,was inappropriate for 35.6% (16/45)patients. Septic shock was presented in 32.3% (21/65) cases with poor outcomes. The overall mortality and morbidity rate from SGNBM were 35.4% and 20%, respectively.

Conclusions: SGNBM is a severe disease resulting to a high rate of mortality and morbidity. Diabetes, taking long-term corticosteroid treatment and strongyloidiasis could be the risks for this condition. It was necessary to use Carbapenem as the empiric antibiotic to cover the ESBL-producing pathogens.