Prognostic factors in adult community-acquired bacterial meningitis: a 4-year retrospective study

  • F. A. Dauchy
  • D. Gruson
  • G. Chêne
  • J. Viot
  • C. Bebear
  • J. Maugein
  • M. C. Bézian
  • H. Dutronc
  • M. Dupon
Concise Article

Abstract

The aim of this 4-year, observational, single-center study was to identify prognostic factors and evaluate the need for intensive care in cases of bacterial meningitis. During the study period, 60 cases of adult bacterial meningitis were identified. Fifty-one patients were transferred to the intensive care unit at various times during their hospital stay. In the multivariate analysis, factors significantly associated with the need for mechanical ventilation and/or vasopressive drugs included comorbidity and a Glasgow coma score of less than 12 at hour 6 following presentation. The results indicate patients with a decreased level of consciousness, neurological deficit or comorbidity should be admitted to the intensive care unit at an early stage of illness. When patients lack these criteria 6 h following presentation, admission to the medical ward is reasonable.

References

  1. 1.
    Auburtin M, Wolff M, Charpentier J et al (2006) Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med 34:2758–2765PubMedCrossRefGoogle Scholar
  2. 2.
    Proulx N, Frechette D, Toye B, Chan J, Kravcik S (2005) Delays in administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM 98:291–298PubMedCrossRefGoogle Scholar
  3. 3.
    de Gans J, van de Beek D (2002) Dexamethasone in adults with bacterial meningitidis. N Engl J Med 347:1549–1556PubMedCrossRefGoogle Scholar
  4. 4.
    Durand ML, Calderwood SB, Weber DJ et al (1993) Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 328:21–28PubMedCrossRefGoogle Scholar
  5. 5.
    Sigurdardottir B, Bjornsson OM, Jonsdottir KE, Erlendsdottir H, Gudmundsson S (1997) Acute bacterial meningitis in adults. A 20-year overview. Arch Intern Med 157:425–430PubMedCrossRefGoogle Scholar
  6. 6.
    Tunkel AR, Hartman BJ, Kaplan SL et al (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284PubMedCrossRefGoogle Scholar
  7. 7.
    Lucht F, Peyramond D, Ragnaud JM (1996) 9° conférence de consensus en thérapeutique anti-infectieuse: les méningites purulentes communautaires. Med Mal Infect 26:1–8CrossRefGoogle Scholar
  8. 8.
    Soussy CJ (2005) Comité de l'antibiogramme de la Société Française de Microbiologie: communiqué 2005Google Scholar
  9. 9.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484PubMedCrossRefGoogle Scholar
  10. 10.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859PubMedCrossRefGoogle Scholar
  11. 11.
    Kastenbauer S, Pfister HW (2003) Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 126:1015–1025PubMedCrossRefGoogle Scholar
  12. 12.
    Flores-Cordero JM, Amaya-Villar R, Rincon-Ferrari MD et al (2003) Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Intensive Care Med 29:1967–1973PubMedCrossRefGoogle Scholar
  13. 13.
    Auburtin M, Porcher R, Bruneel F et al (2002) Pneumococcal meningitis in the intensive care unit: prognostic factors of clinical outcome in a series of 80 cases. Am J Respir Crit Care Med 165:713–717PubMedGoogle Scholar
  14. 14.
    Aronin SI, Peduzzi P, Quagliarello V (1998) Community-acquired Bbacterial meningitidis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 129:862–869PubMedGoogle Scholar
  15. 15.
    Hasbun R, Abrahams J, Jekel J, Quagliarello VJ (2001) Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 345:1727–1733PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • F. A. Dauchy
    • 1
  • D. Gruson
    • 2
  • G. Chêne
    • 3
  • J. Viot
    • 3
  • C. Bebear
    • 4
  • J. Maugein
    • 4
  • M. C. Bézian
    • 4
  • H. Dutronc
    • 1
  • M. Dupon
    • 1
  1. 1.CHU de Bordeaux, Hôpital Pellegrin, Fédération de Maladies infectieusesUniversité Victor Segalen Bordeaux 2Bordeaux cedexFrance
  2. 2.Département de Réanimation médicaleCHU de Bordeaux, Hôpital PellegrinBordeauxFrance
  3. 3.CHU de Bordeaux, Unité de soutien Méthodologique à la recherche clinique et épidémiologique, Université Victor Segalen Bordeaux 2Institut de Santé Publique d’Epidémiologie et de Développement (ISPED)Bordeaux cedexFrance
  4. 4.Laboratoire de bactériologieCHU de Bordeaux, Hôpital Pellegrin et hôpital SudBordeauxFrance

Personalised recommendations