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Dexamethasone treatment in adults with pneumococcal meningitis: risk factors for death

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Abstract

In experimental meningitis, adjunctive treatment with steroids reduces cerebrospinal fluid inflammation and thereby improves neurological outcome. On the basis of these findings, several clinical trials have assessed treatment with adjunctive steroids in bacterial meningitis, with conflicting results. Recently, the results of the European Dexamethasone Study showed a beneficial effect of adjunctive dexamethasone in adults with bacterial meningitis. In that study, the effect of dexamethasone on outcome was most striking in patients with pneumococcal meningitis. The aim of the present study was to further evaluate the effect of dexamethasone in adults with pneumococcal meningitis by performing a post hoc analysis of the European Dexamethasone Study. In a multivariate analysis, tachycardia (p=0.02), advanced age (p=0.03), low score on the Glasgow Coma Scale (p=0.03), positive blood culture (p=0.04), and absence of dexamethasone therapy (p=0.05) were independent predictors for death. Patients who were treated with adjunctive dexamethasone were less likely to develop both systemic and neurological complications during hospitalisation, compared with patients who received placebo. In conclusion, independent risk factors for death in pneumococcal meningitis are tachycardia, advanced age, low level of consciousness, bacteraemia, and absence of dexamethasone therapy. Treatment with adjunctive dexamethasone in adults with pneumococcal meningitis reduces both systemic and neurological complications.

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Acknowledgement

The European Dexamethasone in Adulthood Bacterial Meningitis Study was sponsored by a research grant of NV Organon, the Netherlands (USD 30,000). The study was designed, conducted, and analysed independently of the sponsor. There is no potential conflict of interest for any of the authors involved.

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Correspondence to D. van de Beek.

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Weisfelt, M., van de Beek, D. & de Gans, J. Dexamethasone treatment in adults with pneumococcal meningitis: risk factors for death. Eur J Clin Microbiol Infect Dis 25, 73–78 (2006). https://doi.org/10.1007/s10096-006-0089-z

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