Community-acquired bacterial meningitis in alcoholic patients.
BACKGROUND
Alcoholism is associated with susceptibility to infectious disease, particularly bacterial pneumonia. In the present study we described characteristics in alcoholic patients with bacterial meningitis and delineate the differences with findings in non-alcoholic adults with bacterial meningitis.


RESULTS
This was a prospective nationwide observational cohort study including patients aged >16 years who had bacterial meningitis confirmed by culture of cerebrospinal fluid (696 episodes of bacterial meningitis occurring in 671 patients). Alcoholism was present in 27 of 686 recorded episodes of bacterial meningitis (4%) and alcoholics were more often male than non-alcoholics (82% vs 48%, P = 0.001). A higher proportion of alcoholics had underlying pneumonia (41% vs 11% P<0.001). Alcoholics were more likely to have meningitis due to infection with Streptococcus pneumoniae (70% vs 50%, P = 0.01) and Listeria monocytogenes (19% vs 4%, P = 0.005), whereas Neisseria meningitidis was more common in non-alcoholic patients (39% vs 4%, P = 0.01). A large proportion of alcoholics developed complications during clinical course (82% vs 62%, as compared with non-alcoholics; P = 0.04), often cardiorespiratory failure (52% vs 28%, as compared with non-alcoholics; P = 0.01). Alcoholic patients were at risk for unfavourable outcome (67% vs 33%, as compared with non-alcoholics; P<0.001).


CONCLUSIONS
Alcoholic patients are at high risk for complications resulting in high morbidity and mortality. They are especially at risk for cardiorespiratory failure due to underlying pneumonia, and therefore, aggressive supportive care may be crucial in the treatment of these patients.
Weisfelt
Martijn
M
Department of Neurology, Kennemer Gasthuis, Haarlem, The Netherlands.
de Gans
Jan
J
van der Ende
Arie
A
van de Beek
Diederik
D
D000328:Adult; D000368:Aged; D057229:Alcoholics; D000437:Alcoholism / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008089:Listeria monocytogenes / Q000302:isolation & purification; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000453:epidemiology*; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000302:isolation & purification; D009426:Netherlands / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed