title: Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis.
abstract: We analysed the clinical course of 30 adult patients with Klebsiella pneumoniae meningitis, 18 community-acquired and 12 hospital-acquired, to assess whether the timing of appropriate antimicrobial therapy had a major effect on prognosis. Of the 30 patients, 29 received appropriate antibiotics. The time from initial symptoms to the start of appropriate therapy, antibiotic resistance of K. pneumoniae isolates, underlying disease severity, diabetes mellitus, age, gender, and acquisition settings were all not significantly correlated with outcome. However, a Glasgow coma scale (GCS) score of 7 points or less at the start of appropriate antimicrobial therapy was a valid predictor of death or a permanent vegetative state (sensitivity 82%, specificity 93%, p=0.005), even after adjusting for the effect of confounding variables by logistic regression. Timing of appropriate antimicrobial therapy, as defined by consciousness level but not by symptom duration, is a major determinant of survival and neurological outcome for patients with K. pneumoniae meningitis, and the first dose of an appropriate antibiotic should be administrated before their consciousness deteriorates to a GCS score of 7 points or less.
authors.affiliation: Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital, and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: C T
authors.initials: CT
authors.lastname: Fang
authors.forename: Y C
authors.initials: YC
authors.lastname: Chen
authors.forename: S C
authors.initials: SC
authors.lastname: Chang
authors.forename: W Y
authors.initials: WY
authors.lastname: Sau
authors.forename: K T
authors.initials: KT
authors.lastname: Luh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D012044:Regression Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents