Sex-based differences in adults with community-acquired bacterial meningitis: a prospective cohort study.
OBJECTIVE
To investigate sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis.


METHODS
From January 2006 to July 2014, we prospectively investigated sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis in a nationwide cohort study in the Netherlands. Sex was analysed along with known predictors of unfavourable outcome using logistic regression.


RESULTS
We evaluated 1412 episodes of meningitis, 707 (50%) in men. Men more often presented with a history of remote head injury (41/667 (6%) versus 14/658 (2%) women, p 0.0002) or alcoholism (61/652 (9%) versus 21/660 (3%) women, p <0.0001). Neck stiffness was less common in men (453/651 (70%) versus 524/671 (78%) women, p 0.0004). Despite greater illness severity, women were less likely to receive treatment in an intensive care unit (odds ratio (OR) 0.72, 95% CI 0.58-0.89, p 0.003) or mechanical ventilation (OR 0.67, 95% CI 0.54-0.85, p 0.001). Women exhibited higher serum inflammatory parameters than men (median C-reactive protein 211 versus 171, p 0.0001; median erythrocyte sedimentation rate 48 versus 33, p <0.0001). Corticosteroids improved prognosis in both sexes, but absolute risk reduction was higher in women (20% versus 15%, p 0.001), although we found no significant interaction between sex and dexamethasone (p 0.38). In the multivariable analysis, male sex was an independent predictor of unfavourable outcome (OR 1.34, 95% CI 1.03-1.75, p 0.03) and death (OR 1.47, 95% CI 1.04-2.07, p 0.03).


CONCLUSIONS
Our findings show sex-based differences in adults with community-acquired bacterial meningitis. Male sex is an independent risk factor for adverse outcome. It is possible that sex-based differences in immune reaction could determine a distinct response to corticosteroids.
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Neurology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
S P
SP
Dias
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
M C
MC
Brouwer
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
M W
MW
Bijlsma
Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
A
A
van der Ende
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands. Electronic address: d.vandebeek@amc.uva.nl.
D
D
van de Beek
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D015415:Biomarkers
Bacterial meningitis; Dexamethasone; Gender differences; Infectious diseases; Sex differences