title: Intracerebral hemorrhages in adults with community associated bacterial meningitis in adults: should we reconsider anticoagulant therapy?
abstract: OBJECTIVE
  To study the incidence, clinical presentation and outcome of intracranial hemorrhagic complications in adult patients with community associated bacterial meningitis.
  
  
  METHODS
  Nationwide prospective cohort study from all hospitals in the Netherlands, from 1 March 2006, through 31 December 2010.
  
  
  RESULTS
  Of the 860 episodes of bacterial meningitis that were included, 24 were diagnosed with intracranial hemorrhagic complications: 8 upon presentation and 16 during clinical course. Clinical presentation between patients with or without intracranial hemorrhage was similar. Causative bacteria were Streptococcus pneumoniae in 16 patients (67%), Staphylococcus aureus in 5 (21%), Pseudomonas aeruginosa and Listeria monocytogenes both in 1 patient (4%). Occurrence of intracranial hemorrhage was associated with death (63% vs. 15%, P<0.001) and unfavorable outcome (94% vs. 34%, P<0.001). The use of anticoagulants on admission was associated with a higher incidence of intracranial hemorrhages (odds ratio 5.84, 95% confidence interval 2.17-15.76).
  
  
  CONCLUSIONS
  Intracranial hemorrhage is a rare but devastating complication in patients with community-associated bacterial meningitis. Since anticoagulant therapy use is associated with increased risk for intracranial hemorrhage, physicians may consider reversing or temporarily discontinuing anticoagulation in patients with bacterial meningitis.
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Barry B
authors.initials: BB
authors.lastname: Mook-Kanamori
authors.forename: Daan
authors.initials: D
authors.lastname: Fritz
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000925:Anticoagulants