title: Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study.
abstract: BACKGROUND
  Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice.
  
  
  METHODS
  Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed.
  
  
  RESULTS
  One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15%. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8% of the cohort for 2004 to 30% in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model.
  
  
  CONCLUSIONS
  We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality.
authors: Service de Réanimation Médicale Polyvalente, CHU Nantes, Pôle Hospitalo-universitaire 3, place A. Ricordeau, Nantes, F-44093, France. cedric.bretonniere@chu-nantes.fr.|Faculté de Médecine, Université de Nantes, UPRES EA 3826, 1 rue Gaston Veil, Nantes, F-44035, France. cedric.bretonniere@chu-nantes.fr.
authors: Cédric
authors: C
authors: Bretonnière
authors: Service de Réanimation Médicale Polyvalente, CHU Nantes, Pôle Hospitalo-universitaire 3, place A. Ricordeau, Nantes, F-44093, France. mathieu.jozwiak@aphp.fr.|Service de Réanimation Médicale, AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. mathieu.jozwiak@aphp.fr.
authors: Mathieu
authors: M
authors: Jozwiak
authors: Service de Réanimation Médicale Polyvalente, CHU-Hôpitaux de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, Rouen, F-76000, France. christophe.girault@chu-rouen.fr.|Groupe de Recherche sur le Handicap Ventilatoire (GRHV), UPRES EA 3830-Institut de Recherche et d'Innovation Biomédicale (IRIB), Faculté de Médecine et de Pharmacie, Université de Rouen, Rouen, F-76031, France. christophe.girault@chu-rouen.fr.
authors: Christophe
authors: C
authors: Girault
authors: CH Roanne, Service de Réanimation Médico-chirurgicale, 28 rue de Charlieu, Roanne, F-42300, France. pascal.beuret@ch-roanne.fr.
authors: Pascal
authors: P
authors: Beuret
authors: Service de Réanimation Médicale, AP-HP, Hôpital de la Pitié-Salpêtrière, Institut de Cardiologie, 47-53 boulevard de l'Hôpital, Paris, F-75651, France. jean-louis.trouillet@psl.aphp.fr.
authors: Jean-Louis
authors: JL
authors: Trouillet
authors: Service de Réanimation Médicale, AP-HP, Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, F-94270, France. nadia.anguel@aphp.fr.
authors: Nadia
authors: N
authors: Anguel
authors: Faculté de Médecine, Université de Nantes, UPRES EA 3826, 1 rue Gaston Veil, Nantes, F-44035, France. jocelyne.caillon@univ-nantes.fr.|Service de Bactériologie, CHU Nantes, Pôle Hospitalo-universitaire 7, place A. Ricordeau, Nantes, F-44093, France. jocelyne.caillon@univ-nantes.fr.
authors: Jocelyne
authors: J
authors: Caillon
authors: Faculté de Médecine, Université de Nantes, UPRES EA 3826, 1 rue Gaston Veil, Nantes, F-44035, France. gilles.potel@chu-nantes.fr.|Service d'Accueil des Urgences, CHU Nantes, Pôle Hospitalo-universitaire 3, 'place A. Ricordeau, Nantes, F-44093, France. gilles.potel@chu-nantes.fr.
authors: Gilles
authors: G
authors: Potel
authors: Service de Réanimation Médicale Polyvalente, CHU Nantes, Pôle Hospitalo-universitaire 3, place A. Ricordeau, Nantes, F-44093, France. daniel.villers@chu-nantes.fr.
authors: Daniel
authors: D
authors: Villers
authors: Faculté de Médecine, Université de Nantes, UPRES EA 3826, 1 rue Gaston Veil, Nantes, F-44035, France. david.boutoille@chu-nantes.fr.|Service des Maladies Infectieuses, CHU Nantes, Pôle Hospitalo-universitaire 3, place A. Ricordeau, Nantes, F-44093, France. david.boutoille@chu-nantes.fr.
authors: David
authors: D
authors: Boutoille
authors: Service de Réanimation Médicale Polyvalente, CHU Nantes, Pôle Hospitalo-universitaire 3, place A. Ricordeau, Nantes, F-44093, France. christophe.guitton@chu-nantes.fr.
authors: Christophe
authors: C
authors: Guitton
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections; D005260:Female; D005602:France / Q000453:epidemiology; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality; D008585:Meningitis, Meningococcal / Q000188:drug therapy / Q000401:mortality; D008586:Meningitis, Pneumococcal / Q000188:drug therapy; D008875:Middle Aged; D009345:Neisseria meningitidis; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin