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Войти в исследования International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025
Causative pathogens and predictors of unfavourable outcomes in central nervous system infections in resource-limited settings.
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Dong Do Van, Sang Vu Viet, Hoan Nghiem Xuan, Ha Nguyen Viet, Linh Nguyen Thi Khanh, Sy Bui Tien, The Nguyen Trong, Quang Hoang Xuan, Lien Tran Thi, Trang Van Dinh, Kremsner Peter G, Song Le Huu, Peter Silke, Nurjadi Dennis, Velavan Thirumalaisamy P
Аннотация
OBJECTIVES: This study investigated the impact of causative pathogens on the outcomes of central nervous system (CNS) infections and assessed clinical parameters to identify patients at risk for unfavourable outcomes.
METHODS: Patients with suspected CNS infections underwent blood and cerebrospinal fluid (CSF) culture and advanced molecular testing, including real-time PCR assays for bacterial and viral pathogens. Patients were classified into clinical categories and their outcomes assessed using the Glasgow Outcome Scale.
RESULTS: Pathogens were identified in 24% (80/330) of patients, with Mycobacterium tuberculosis, Klebsiella pneumoniae, and Acinetobacter baumannii being the most common. Mortality was 10%, with fungal meningitis and dual infections having the highest rates. Unfavourable outcomes were observed in 57% of patients. The most common pathogens associated with unfavourable outcomes were M. tuberculosis followed by K. pneumoniae, A. baumannii, and HSV-1. Multivariate analysis identified community-onset infection as a protective factor, while a longer duration of illness before admission (≥5 days) and altered mental status on admission were significant predictors for unfavourable outcomes. Furthermore, the timely administration of appropriate empirical therapy was significantly associated with a reduced risk of mortality.
CONCLUSIONS: CNS infections in northern Vietnam have diverse causes and overlapping clinical features, complicating diagnosis and management.
METHODS: Patients with suspected CNS infections underwent blood and cerebrospinal fluid (CSF) culture and advanced molecular testing, including real-time PCR assays for bacterial and viral pathogens. Patients were classified into clinical categories and their outcomes assessed using the Glasgow Outcome Scale.
RESULTS: Pathogens were identified in 24% (80/330) of patients, with Mycobacterium tuberculosis, Klebsiella pneumoniae, and Acinetobacter baumannii being the most common. Mortality was 10%, with fungal meningitis and dual infections having the highest rates. Unfavourable outcomes were observed in 57% of patients. The most common pathogens associated with unfavourable outcomes were M. tuberculosis followed by K. pneumoniae, A. baumannii, and HSV-1. Multivariate analysis identified community-onset infection as a protective factor, while a longer duration of illness before admission (≥5 days) and altered mental status on admission were significant predictors for unfavourable outcomes. Furthermore, the timely administration of appropriate empirical therapy was significantly associated with a reduced risk of mortality.
CONCLUSIONS: CNS infections in northern Vietnam have diverse causes and overlapping clinical features, complicating diagnosis and management.