Prognostic factors of community-acquired purulent meningitis outcome in adults
Authors:
Džupová Olga 1; Rozsypal Hanuš 2; Beneš Jiří 1
Authors‘ workplace:
Klinika infekčních nemocí 3. LF UK a FN Na Bulovce, Praha
1; III. klinika infekčních a tropických nemocí 1. LF UK, Praha
2
Published in:
Anest. intenziv. Med., 20, 2009, č. 6, s. 317-323
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
To assess the clinical outcome of acute bacterial meningitis in adults and to identify predictors of unfavourable outcome.
Design:
Prospective longitudinal observational study.
Setting:
Department of infectious diseases, university hospital.
Materials and methods:
The study included patients of ≥ 16 years of age treated for community-acquired bacterial meningitis. Medical history and clinical laboratory data were recorded. Clinical outcome was classified using the Glasgow Outcome Scale (GOS 1–5) and dichotomized to favourable (GOS 5) and unfavourable (GOS 1–4) outcomes. The significance of the prognostic factors was statistically analyzed by univariate and multivariate analysis.
Results:
Between 1997 and 2006, 279 adults (122 women, 157 men) with median age of 51 years were admitted for community-acquired acute bacterial meningitis. Predisposing conditions (a primary focus or disrupted dural barrier) and comorbidities were recorded in 42% and 38% of patients, respectively. Time from symptoms onset to antibiotic treatment start was ≤ 48 hours in 82% of patients. Fifty-five patients (20%) died and 63 (23%) had neurological sequelae. Multivariate analysis revealed these independent predictors of unfavourable outcome: a medical comorbidity, time to treatment > 48 hours, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology.
Conclusion:
The results document the significant case fatality ratio and sequelae rates of acute bacterial meningitis in adults. Among the identified prognostic factors, only time to treatment can be influenced. Early clinical suspicion in a patient with corresponding symptoms should lead to immediate diagnostic testing and start of treatment. This approach is likely to increase the chances of a favourable outcome.
Keywords:
acute bacterial meningitis – clinical outcome – case fatality ratio – prognostic factors
Sources
1. Teasdale, G. M., Pettigrew, L. E., Wilson, J. T., Murray, G., Jennett, B. Analyzing outcome of treatment of severe head injury: A review and update on advancing the use of the Glasgow Outcome Scale. J. Neurotrauma, 1998, 15, p. 587–597.
2. Bohr, V., Rasmussen, N., Hansen, B., Gade, A., Kjersem, H., Johnsen, N., Paulsson, O. Pneumococcal meningitis: an evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae. J. Inf., 1985, 10, p. 143–157.
3. Durand, M. L., Calderwood, S. B., Weber, D. J., Miller, S. I., Southwick, F. S., Caviness, V. S., Swartz, M. N. Acute bacterial meningitis in adults. A review of 493 episodes. N. Engl. J. Med., 1993, 328, p. 21–28.
4. Hodges, G. R., Perkins, R. L. Acute bacterial meningitis: An analysis of factors influencing prognosis. Am. J. Med. Sci., 1975, 270, p. 427–440.
5. Sigurdardottir, B., Bjornsson, O. M., Jonsdottir, K. E., Erlendsdottir, H., Gudmundsson, S. Acute bacterial meningitis in adults. A 20-year overview. Arch. Intern. Med., 1997, 157, p. 425–430.
6. Stanek, R. J., Mufson, M. A. A 20-year epidemiological study of pneumococcal meningitis. Clin. Inf. Dis., 1999, 28, p. 1265–1272.
7. Tang, L. M., Chen, S. T., Hsu, W. C., Lyu, R. K. Acute bacterial meningitis in adults: a hospital-based epidemiological study. Q. J. Med., 1999, 92, p. 719–725.
8. van de Beek, D., de Gans, J., Spanjaard, L., Weisfelt, M., Reitsma, J. B., Vermeulen, M. Clinical features and prognostic factors in adults with bacterial meningitis. N. Engl. J. Med., 2004, 351, p. 1849–1859.
9. Weisfelt, M., van de Beek, D., Spanjaard, L., Reitsma, J. B., de Gans, J. Clinical features, complications, and outcome in adults with pneumococcal meningitis: A prospective case series. Lancet Neurol., 2006, 5, p. 123–129.
10. Weiss, W., Figueroa, W., Shapiro, W. H., Flippin, H. F. Prognostic factors in pneumococcal meningitis. Arch. Intern. Med., 1967, 120, p. 517–524.
11. Flores-Cordero, J. M., Amaya-Villar, R., Rincón-Ferrari, M. D., Leal-Noval, S. R., Garnacho-Montero, J., Llanos-Rodríguez, A. C., Murillo-Cabezas, F. Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Intensive Care Med., 2003, 29, p. 1967–1973.
12. Hussein, A. S., Shafran, S. D. Acute bacterial meningitis in adults. A 12 year review. Medicine, 2000, 79, p. 360–368.
13. Lu, C. H., Huang, C. R., Chang, W. N., Chang, C. J., Cheng B. C., Lee, P. Y., Lin, M. W., Chang, H. W. Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors. Clin. Neurol. Neurosurg., 2002, 104, p. 352–358.
14. McMillan, D. A., Lin, C. Y., Aronin, S. I., Quagliarello, V. J. Community-acquired bacterial meningitis in adults: categorization of causes and timing of death. Clin. Infect. Dis., 2001, 33, p. 969–975.
15. Meyer, C. N., Samuelsson, I. S., Galle, M., Bangsborg, J. M. Adult bacterial meningitis: aetiology, penicillin susceptibility, risk factors, prognostic factors and guidelines for empirical antibiotic treatment. Clin. Micro. Infect., 2004, 10, p. 709–717.
16. Miner, J. R., Heegaard, W., Mapes, A., Biros, M. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center. J. Emerg. Medicine, 2001, 21, p. 387–392.
17. Pfister, H. W., Feiden, W., Einhaupl, K. M. Spectrum of complications during bacterial meningitis in adults: results of a prospective clinical study. Arch. Neurol., 1993, 50, p. 575–581.
18. Proulx, N., Fréchette, D., Toye, B., Chan, J., Kravcik, S. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Q. J. Med., 2005, 98, p. 291–298.
19. Auburtin, M., Porcher, R., Bruneel, F., Scanvic, A., Trouillet, J. L., Bédos, J. P., Régnier, B., Wolff, M. Pneumococcal meningitis in the intensive care unit: Prognostic factors of clinical outcome in a series of 80 cases. Am. J. Respir. Crit. Care Med., 2002, 165, p. 713–717.
20. Bruyn, G. A., Kremer, H. P., de Marie, S., Padberg, G. W., Hermans, J., van Furth, R. Clinical evaluation of pneumococcal meningitis in adults over a twelve-year period. Eur. J. Clin. Microbiol. Infect. Dis., 1989, 8, p. 695–700.
21. Hoen, B., Viel, J. F., Gérard, A., Dureux, J. B., Canton, P. Mortality in pneumococcal meningitis: A multivariate analysis of prognostic factors. Eur. J. Med., 1993, 2, p. 28–32.
22. Kastenbauer, S., Pfister, H. W. Pneumococcal meningitis in adults. Spectrum of complications and prognostic factors in a series of 87 cases. Brain, 2003, 126, p. 1015–1025.
23. Aronin, S. I., Peduzzi, P., Quagliarello, V. J. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann. Intern. Med., 1998, 129, p. 862–869.
24. Radetsky, M. Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr. Infect. Dis. J., 1992, 11, p. 694–698.
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2009 Issue 6
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