Pseudomonas aeruginosa central nervous system infections: analysis of clinical features of 16 adult patients.
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 focal 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 spontaneous 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 predisposing 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.
Chuang
Y C
YC
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Taiwan, ROC.
Chang
W N
WN
Lu
C H
CH
Wu
H S
HS
Chang
H W
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001922:Brain Abscess / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D011379:Prognosis; D011552:Pseudomonas Infections / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies