title: Dramatic reduction of mortality in pneumococcal meningitis.
abstract: BACKGROUND
  Acute bacterial meningitis is still a life threatening disease.
  
  
  METHODS
  We performed a retrospective observational study on the clinical characteristics of consecutively admitted patients with acute pneumococcal meningitis in a single tertiary care center in central Europe (from 2003 until 2015). Data were compared with a previously published historical group of 87 patients treated for pneumococcal meningitis at the same hospital (from 1984 until 2002).
  
  
  RESULTS
  Fifty-five consecutive patients with microbiologically proven pneumococcal meningitis were included. Most striking, mortality was down to 5.5 %, which was significantly lower than in the historical group where 24.1 % of the patients did not survive. Intracranial complications during the course of the disease were common and affected half of the patients. Unlike in the historic group, most of the intracranial complications (except ischemic stroke) were no longer associated with a low Glasgow Outcome Score at discharge.
  
  
  CONCLUSIONS
  The drastic reduction of mortality proves there have been important advances in the treatment of pneumococcal meningitis. Nevertheless, the fact that only 44.2 % of survivors had a full recovery indicates that the search for new adjunctive treatment options must be ongoing.
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Grete
authors.initials: G
authors.lastname: Buchholz
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Koedel
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Hans-Walter
authors.initials: HW
authors.lastname: Pfister
authors.affiliation: Praxis für Neurologie, Destouchesstrasse 73, 80796, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kastenbauer
authors.affiliation: Emergency Department, Klinikum Grosshadern, Ludwig Maximilians University, Marchioninistr, 15, 81377, Munich, Germany. matthias.klein@med.uni-muenchen.de.
authors.forename: Matthias
authors.identifier: http://orcid.org/0000-0001-9064-6865
authors.initials: M
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D003907:Dexamethasone / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000401:mortality*; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000494:pharmacology* / Q000627:therapeutic use; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids; D002443:Ceftriaxone; D003907:Dexamethasone
keywords: Bacterial meningitis; CNS infection; Intracranial complications; Neurocritical care; Pneumococcal meningitis; Streptococcus pneumoniae