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.
Keywords: Bacterial meningitis; Central nervous system infections; Fungal meningitis; Tuberculous meningitis; Vietnam; Viral encephalitis/meningitis.
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