title: Therapeutic hypothermia for adult community-acquired bacterial meningitis-historical control study.
abstract: OBJECTIVE
  Despite advances in antibiotic therapy and critical care, community-acquired bacterial meningitis (CABM) continues to have poor outcome in a significant portion of patients. This study was designed to assess the efficacy of therapeutic hypothermia (TH) in the treatment of CABM.
  
  
  METHODS
  In a period from January 2009 to January 2013, 41 enrolled patients with CABM were treated with TH. Their outcome was compared to 90 patients in the historical control group that were recruited from the existing database and included patients in a period between 1994 and 2008 with Glasgow coma scale score (GCS) ≤9 and respiratory failure. TH was indicated in patients with GCS ≤9, respiratory failure, and breath holding index ≤0.835 (measured with transcranial Doppler). If the acoustic window was absent, GCS ≤9 plus optic nerve sheath diameter of ≥6mm plus respiratory failure were indications for TH.
  
  
  RESULTS
  Outcome variables were mortality and neurologic recovery measured with the Glasgow outcome scale (GOS). The incidence of hospital mortality (19.5% vs 48.9%, p=0.002) and adverse neurological outcome (GOS 1-3) (43.9% vs 65.6%, p=0.023) were significantly lower in patients treated with TH. Multivariate analysis confirmed the positive effect of TH on hospital mortality (OR=0.059, 95% CI 0.017-0.211) and risk of adverse neurological outcome (OR=0.209, 95% CI 0.082-0.534) after an adjustment for other risk factors of unfavorable patients' outcome.
  
  
  CONCLUSIONS
  The new therapeutic concept based on hypothermia significantly improves the outcome in adult patients with severe CABM.
authors: University of Zagreb, School of Medicine, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Department of Intensive Care Medicine and Neuroinfectology, Zagreb, Croatia. Electronic address: mkutlesa@bfm.hr.
authors: Marko
authors: M
authors: Kutleša
authors: University of Zagreb, School of Dental Medicine, Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia. Electronic address: lepurix@inet.hr.
authors: Dragan
authors: D
authors: Lepur
authors: University of Zagreb, School of Medicine, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Department of Intensive Care Medicine and Neuroinfectology, Zagreb, Croatia. Electronic address: bbarsic@bfm.hr.
authors: Bruno
authors: B
authors: Baršić
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D065386:Historically Controlled Study; D006801:Humans; D007036:Hypothermia, Induced; D015994:Incidence; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacterial meningitis; Clinical outcome; Therapeutic hypothermia