title: Improved outcome of bacterial meningitis associated with use of corticosteroid treatment.
abstract: Background The aim of this study was to evaluate the clinical outcome of patients with bacterial meningitis following the introduction of dexamethasone treatment in Denmark. Methods Adult patients with bacterial meningitis, admitted from 2003-2010 to two different university hospitals, were included retrospectively. Data at clinical presentation, Glasgow outcome scale (GOS), cerebrospinal fluid and blood biochemistry were collected. Relative risk (RR) with 95% confidence interval (CI) was computed by Cox proportional hazard regression analysis. Results One hundred and forty-seven patients were included in the study. The population had a median age of 62 years and 31% had an immunosuppressive co-morbidity. Eighty-nine patients had an unfavourable outcome (GOS score = 1-4). Adjuvant treatment with corticosteroids (RR = 0.48; 95% CI = 0.30-0.76) was associated with a favourable outcome (GOS score = 5), while altered mental status (RR = 2.36; 95% CI = 1.17-4.78) and age (RR = 1.03; 95% CI = 1.01-1.04) per year increment was associated with an unfavourable outcome. Adjuvant corticosteroid treatment did not affect short- or long-term survival. Short-term mortality was influenced by age (RR = 1.06; 95% CI = 1.04-1.09). Long-term mortality was influenced by age (RR = 1.06; 95% CI = 1.03-1.08) and female sex (RR = 1.81; 95% CI = 1.05-3.14). Conclusion This study indicated that adjuvant corticosteroid treatment in acute bacterial meningitis improves the outcome and can safely be administered in an elderly population with high levels of immunosuppressive co-morbidity.
authors.affiliation: a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.|b Department of Infectious Diseases.
authors.forename: Gertrud
authors.initials: G
authors.lastname: Baunbæk-Knudsen
authors.affiliation: a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Sølling
authors.affiliation: c Department of Clinical Biochemistry , Hvidovre Hospital, University of Copenhagen , Hvidovre , Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Farre
authors.affiliation: b Department of Infectious Diseases.
authors.forename: Thomas
authors.initials: T
authors.lastname: Benfield
authors.affiliation: a Department of Pulmonary and Infectious Diseases , Nordsjaelland Hospital, University of Copenhagen , Hillerød , Denmark.|b Department of Infectious Diseases.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Brandt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D003907:Dexamethasone
keywords: Bacterial meningitis; corticosteroid treatment; outcome