title: Cerebral infarction in adults with bacterial meningitis.
abstract: BACKGROUND
  To evaluate clinical features and prognostic factors of cerebral infarctions in adults with community-acquired bacterial meningitis.
  
  
  METHODS
  An observational cross-sectional study, including 696 patients of whom 174 had cerebral infarction, from a prospective nationwide cohort of community-acquired bacterial meningitis (period, 1998-2002), confirmed by culture of cerebral spinal fluid (CSF) in patients aged over 16 years. Two investigators independently determined the presence of infarction.
  
  
  RESULTS
  Cerebral infarction occurred in 174 episodes (25%), with a high inter-rater agreement for determining the presence of cerebral infarction (kappa 0.95). Cerebral infarctions occurred in 128 of 352 patients (36%) with pneumococcal meningitis, in 22 of 257 (9%) with meningococcal meningitis and in 24 of 87 patients (28%) with meningitis caused by other bacteria. Patients with infarctions were older (P < 0.001) and often presented with predisposing conditions, such as otitis and/or sinusitis (P = 0.001) or an immunocompromised state (P = 0.003) compared to those without infarction. Patients with infarctions presented with lower scores on the Glasgow Coma Scale (P < 0.001), lower CSF white cell counts (P = 0.001), and higher serum erythrocyte sedimentation rate (ESR) (P < 0.001). Unfavorable outcome occurred in 108 (62%) patients with infarctions. In a multivariate analysis, infarction was related with unfavorable outcome (odds ratio 3.37; 95% confidence interval 2.19-5.21; P < 0.001). We identified lower CSF white cell counts and high ESR to be independent risk factors for cerebral infarction.
  
  
  CONCLUSIONS
  Cerebral infarction is a common and severe complication in adults with community-acquired bacterial meningitis. Preventing cerebral infarctions will be important in reducing the high morbidity and mortality rate in adults with community-acquired bacterial meningitis.
authors: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 Amsterdam, The Netherlands.
authors: Ewout S
authors: ES
authors: Schut
authors: Marjolein J
authors: MJ
authors: Lucas
authors: Matthijs C
authors: MC
authors: Brouwer
authors: Mervyn D I
authors: MD
authors: Vergouwen
authors: Arie
authors: A
authors: van der Ende
authors: Diederik
authors: D
authors: van de Beek
mesh_terms: D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000453:epidemiology* / Q000382:microbiology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology*; D008585:Meningitis, Meningococcal / Q000453:epidemiology; D008586:Meningitis, Pneumococcal / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index