title: Predictors of inferior outcome in community acquired bacterial meningitis.
abstract: The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).
authors.affiliation: St. Elizabeth University Tropical Projects, Slovakia, Slovakia.
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authors.lastname: Streharova
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authors.lastname: Krcmery
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authors.lastname: Kisac
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authors.lastname: Kalavsky
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authors.lastname: Holeckova
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authors.lastname: Lesnakova
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authors.lastname: Luzinsky
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authors.lastname: Adamkovicova
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authors.lastname: Pavlikova
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authors.lastname: Spilakova
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authors.lastname: Dovalova
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authors.lastname: Wiczmandyova
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authors.lastname: Chovancova
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authors.lastname: Kovac
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authors.lastname: Ondrusova
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authors.lastname: Bauer
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authors.lastname: Benca
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authors.lastname: Rudinsky
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authors.lastname: Sramka
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authors.lastname: Kralova
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authors.lastname: Krsakova
authors.forename: M
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authors.lastname: Krumpolcova
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authors.initials: L
authors.lastname: Findova
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authors.initials: V
authors.lastname: Svabova
authors.forename: V
authors.initials: V
authors.lastname: Sladeckova
authors.forename: S
authors.initials: S
authors.lastname: Seckova
authors.forename: J
authors.initials: J
authors.lastname: Saniova
authors.forename: B
authors.initials: B
authors.lastname: Pavlicova
authors.forename: M
authors.initials: M
authors.lastname: Taziarova
authors.forename: P
authors.initials: P
authors.lastname: Bukovinova
authors.forename: A
authors.initials: A
authors.lastname: Kolenova
authors.forename: E
authors.initials: E
authors.lastname: Horvathova
authors.forename: F
authors.initials: F
authors.lastname: Hvizdak
authors.forename: R
authors.initials: R
authors.lastname: Luzica
authors.forename: B
authors.initials: B
authors.lastname: Rolnikova
authors.forename: A
authors.initials: A
authors.lastname: Bocakova
authors.forename: E
authors.initials: E
authors.lastname: Grey
authors.forename: M
authors.initials: M
authors.lastname: Bielova
authors.forename: M
authors.initials: M
authors.lastname: Huttova
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authors.initials: I
authors.lastname: Sabo
authors.forename: N
authors.initials: N
authors.lastname: Jalili
mesh_terms: D000437:Alcoholism / Q000150:complications* / Q000401:mortality; D001925:Brain Damage, Chronic / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000150:complications / Q000401:mortality / Q000628:therapy; D003920:Diabetes Mellitus; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D016920:Meningitis, Bacterial / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D018154:Slovakia; D017211:Treatment Failure