Acute bacterial meningitis in adults: predictors of outcome.
Case fatality ratio and permanent sequelae of acute bacterial meningitis remain high in recent decades. A prospective longitudinal study of adult patients admitted with community acquired acute bacterial meningitis at a tertiary infectious diseases unit aimed to identify predictors of unfavourable outcome - death and sequelae. Anamnestic, clinical and laboratory data and clinical outcome were recorded. From 1997 to 2006, 279 adults (122F, 157M) with a median age of 51 y were admitted with acute bacterial meningitis. Predisposing condition and comorbidity were recorded in 42% and 38% of patients, respectively. Time between symptoms onset and antibiotic treatment ranged from 6 to 160 h. An aetiological agent was identified in 77% of patients: Streptococcus pneumoniae (29%) and Neisseria meningitidis (27%) were the most frequent. 55 patients (20%) died and 63 (23%) had neurological sequelae 6 months after discharge. In multivariate analysis, 7 independent predictors of unfavourable outcome were identified: internal comorbidity, time to treatment >48 h, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology. The results suggest that acute bacterial meningitis remains associated with significant morbidity and mortality. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential for an optimal clinical outcome.
Dzupova
Olga
O
Third Faculty of Medicine, Bulovka University Hospital, Prague, Czech Republic. olga.dzupova@lf3.cuni.cz
Rozsypal
Hanus
H
Prochazka
Bohumir
B
Benes
Jiri
J
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins; D003128:Coma; D015897:Comorbidity; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007022:Hypotension; D008137:Longitudinal Studies; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D011379:Prognosis; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins; D005947:Glucose