Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors.
OBJECTIVE
To study the clinical features, management and prognostic factors associated with adverse clinical outcome in a series of patients with acute community-acquired bacterial meningitis admitted to the intensive care unit (ICU).


METHODS
Descriptive, prospective study at two ICUs of a university hospital over a 6-year period.


METHODS
Sixty-four episodes in 62 adults with acute community-acquired bacterial meningitis admitted to the ICU.


RESULTS
Most of the patients (95.3%) were admitted to the ICU presenting with altered mental status (the median value of Glasgow Coma Scale (GCS) was 11). Overall mortality rate was 10.9% (7 patients) and 11 (17.1%) developed adverse clinical outcome (death or severe neurologic deficit). The features associated with adverse clinical outcome were: age over 50 years, seizures or focal neurologic signs at admission, a GCS score of 10 or less and an APACHE II score more than 13 at admission to the ICU. Only the severity of the disease determined according to the APACHE II scale was independently associated with adverse clinical outcome after a multivariate analysis was performed (adjusted odds ratio =8.74; 95% CI =1.70-44.77; p=0.009). All patients were empirically treated with third-generation cephalosporins and dexamethasone was used in 40 cases (62.5%). Ten patients (15.6%) received mannitol, nine of them after a transcranial Doppler sonography recording had been performed.


CONCLUSIONS
In adult patients with acute community-acquired bacterial meningitis admitted to the ICU, the overall severity of the disease within 24 h of admission may be the major indicator of adverse in-hospital clinical outcome.
Flores-Cordero
Juan M
JM
Critical Care and Emergency Department, University Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain. juanmflores@inicia.es
Amaya-Villar
Rosario
R
Rincón-Ferrari
Maria D
MD
Leal-Noval
Santiago R
SR
Garnacho-Montero
José
J
Llanos-Rodríguez
Ana C
AC
Murillo-Cabezas
Francisco
F
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents