Hospital-based study of the prognostic factors in adult patients with acute community-acquired bacterial meningitis in Tokyo, Japan.
BACKGROUND
Prognostic factors related to community-acquired bacterial meningitis (BM) in adult patients have been evaluated using multivariate analysis in The Netherlands, where the rate of antibiotic resistance was low. However, an evaluation of these factors in countries with a high rate of antibiotic resistance has not yet been done. Thus, we studied the prognostic factors in adults with community-acquired BM in our hospitals, which are located in Tokyo, Japan, where the rate of antibiotic resistance is high.


METHODS
We selected 71 consecutive adult patients with community-acquired BM in which the pathogens were identified and then classified the patients into two groups based on the Glasgow Outcome Scale: a favorable outcome group (n=48), and an unfavorable outcome group (n=23). Their clinical and laboratory variables were analyzed using single logistic regression analysis followed by multiple logistic regression analysis.


RESULTS
The overall mortality rate was 23%. The rate of antibiotic resistance was 54.9%. The most common resistant bacteria were penicillin-resistant Streptococcus pneumoniae, followed by methicillin-resistant Staphylococcus aureus. The Glasgow Coma Scale score (GCS) at the initiation of antibiotic therapy and a low thrombocyte count were identified as significant unfavorable prognostic factors (GCS: p=0.020, odds ratio=0.528, 95%CI=0.309-0.902; thrombocyte count: p=0.037, odds ratio=0.802, 95%CI=0.652-0.987). The presence of antibiotic-resistant bacteria was not identified as a prognostic factor.


CONCLUSIONS
Patients with a low GCS at the initiation of antibiotic therapy and low thrombocyte counts had unfavorable outcomes. With appropriate antibiotic administration, the antibiotic-resistant bacteria were not identified as an unfavorable prognostic factor, even in an area with a high rate of antibiotic resistance.
Ishihara
Masaki
M
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo.
Kamei
Satoshi
S
Taira
Naoto
N
Morita
Akihiko
A
Miki
Kenji
K
Naganuma
Tomoka
T
Minami
Masayuki
M
Shiota
Hiroshi
H
Hara
Motohiko
M
Mizutani
Tomohiko
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001792:Blood Platelets / Q000473:pathology; D002648:Child; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D024881:Drug Resistance, Bacterial / Q000208:ethnology; D005260:Female; D015600:Glasgow Coma Scale; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D014041:Tokyo / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents