title: Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study.
abstract: OBJECTIVE
  To identify factors associated with mortality and morbidity among adults admitted to intensive care units (ICUs) for pneumococcal meningitis, particularly the impact of delayed antibiotic administration.
  
  
  METHODS
  We conducted a prospective, multicenter, observational study of 156 consecutive adults hospitalized for pneumococcal meningitis. We analyzed parameters associated with 3-month survival.
  
  
  METHODS
  Fifty-six medical and medical-surgical ICUs in France.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 148 strains isolated, 56 (38%) were nonsusceptible to penicillin G. At 3 months after ICU admission, the mortality rate was 33% (51/156), and 34% of survivors (36/105) had neurologic sequelae. Multivariate analysis identified three variables as independently associated with 3-month mortality: Simplified Acute Physiology Score II (odds ration [OR], 1.12; 95% confidence interval [CI], 1.072-1.153; p = .002); isolation of a nonsusceptible strain (OR, 6.83; 95% CI, 2.94-20.8; p < 10(-4)), and an interval of >3 hrs between hospital admission and administration of antibiotics (OR, 14.12; 95% CI, 3.93-50.9; p < 10(-4)). In contrast, a cerebrospinal fluid leukocyte count >10(3) cells/microL had a protective effect (OR, 0.30; 95% CI, 0.10-0.944; p = 0.04).
  
  
  CONCLUSIONS
  Independent of severity at the time of ICU admission, isolation of penicillin-nonsusceptible strains and a delay in antibiotic treatment following admission were predictors of mortality among patients with pneumococcal meningitis.
authors.affiliation: From the Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, AP-HP, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Auburtin
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Varon
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Christophe
authors.initials: C
authors.lastname: Girault
authors.forename: Ismaël
authors.initials: I
authors.lastname: Mohammedi
authors.forename: Benoît
authors.initials: B
authors.lastname: Renard
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D010403:Penicillin Resistance; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents