Hydrocephalus in adults with community-acquired bacterial meningitis.
OBJECTIVE
To evaluate the occurrence, treatment, and outcome of hydrocephalus complicating community-acquired bacterial meningitis in adults.


METHODS
Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2009.


RESULTS
Hydrocephalus was diagnosed in 26 of 577 episodes (5%) and was classified as communicating hydrocephalus in all but 1 patient. The majority of patients (69%) presented with hydrocephalus on admission. Most common causative bacteria were Streptococcus pneumoniae (in 14 patients, 54%) and Listeria monocytogenes (in 4 patients, 15%). Thirteen patients died (50%) and 18 had an unfavorable outcome (69%). Hydrocephalus was an independent predictor of death in a multivariate analysis (odds ratio 7.81, 95% confidence interval 2.91-20.8). Six patients underwent an intervention: 2 patients (8%) had serial lumbar punctures; 4 patients (15%) underwent external ventricular CSF catheter placement. Median time from diagnosis of hydrocephalus to CSF shunting was 12 hours (range 0-4 days). All patients who underwent CSF shunting died or had a poor outcome.


CONCLUSIONS
Hydrocephalus complicates community-acquired bacterial meningitis in 5% of adult cases and is associated with high fatality rates. A minority of patients underwent neurosurgery and outcome was uniformly poor in these patients.
Kasanmoentalib
E Soemirien
ES
Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Brouwer
Matthijs C
MC
van der Ende
Arie
A
van de Beek
Diederik
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery*; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012307:Risk Factors; D016896:Treatment Outcome