[Bacterial meningitis in adults in the intensive care unit. Clinical analysis and study of prognostic factors].
OBJECTIVE
Bacterial meningitis frequently leads to hospitalization in the intensive care unit. Despite progress in antibiotics, prognosis remains poor.


METHODS
We analyzed the clinical manifestations and complications which occurred in 41 patients admitted to the intensive care unit for bacterial meningitis. A case-control survey was used to determine prognosis factors.


RESULTS
All patients required ventilatory assistance and 83% were in a state of coma at admission. Causal germs isolated were: Pneumococci 34%, Listeria 22%, Staphylococcus aureus 17%, and Gram-positive bacilli 12%. Overall mortality was 56%. The main prognosis factors after univariate analysis were age, delay to treatment, presence of septic shock, bacteriemia at admission, low cell count in first lumbar tap, high urea level and low protein level. After multivariate analysis, the following risk factors were retained: low number of leukocytes at first lumbar tap and high urea level.


CONCLUSIONS
The gravity of bacterial meningitis in the intensive care unit appears to be related to the patient's overwhelmed defense system and especially to hemodynamic disorders with acute renal failure and capillary hyperpermeability leading to insufficient cerebral perfusion.
Milhaud
D
D
Service de Soins intensifs et de Réanimation neurologique, CHU de Montpellier.
Bernardin
G
G
Rastello
M
M
Matteï
M
M
Blard
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D005602:France / Q000453:epidemiology; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013997:Time Factors
Méningites bactériennes de l'adulte en réanimation médicale. Analyse clinique et étude des facteurs pronostiques.