Adult community-acquired bacterial meningitis requiring ICU admission: epidemiological data, prognosis factors and adherence to IDSA guidelines

  • H. Georges
  • A. Chiche
  • S. Alfandari
  • P. Devos
  • N. Boussekey
  • O. Leroy
Article

Abstract

Numerous guidelines are available to guide empirical antimicrobial therapy (EAT) in acute bacterial meningitis (ABM) patients. We analysed prognosis factors and compliance to the Infectious Diseases Society of America (IDSA) guidelines in ABM patients requiring stay in an intensive care unit (ICU). A 10-year retrospective study, using prospectively collected data, in 82 ABM patients admitted to a 16-bed university-affiliated French ICU was undertaken. Seventeen patients (20.7%) died during ICU stay. Multivariate analysis isolated four factors associated with in-ICU death: alcoholism (P = 0.007), acute kidney injury (P = 0.006), age >60 years (P = 0.006) and ICU admission for neurological failure (P = 0.01). Causative pathogens were isolated for 62 (75.6%) patients, including 29 pneumococci, 14/28 of which were non-susceptible to penicillin. No characteristics, particularly recent hospitalisation and/or antibiotic delivery, was associated with penicillin susceptibility. Compliance to IDSA guidelines was 65%. Non-compliance concerned to be essentially the non-delivery or low dosage of vancomycin. Treatment compatible with IDSA guidelines was associated with a decreased ICU mortality in univariate (61.5% survival vs. 35.3%, P = 0.05) but not in multivariate analysis. In-ICU mortality associated with ABM remains high. Prognosis factors are related to the severity of disease or underlying conditions. Penicillin non-susceptible Streptococcus pneumoniae can occur without any of the usual predisposing factors.

Keywords

Vancomycin Intensive Care Unit Admission Intensive Care Unit Stay Glasgow Outcome Scale Glasgow Coma Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • H. Georges
    • 1
  • A. Chiche
    • 1
  • S. Alfandari
    • 1
  • P. Devos
    • 2
  • N. Boussekey
    • 1
  • O. Leroy
    • 1
  1. 1.Intensive Care and Infectious Disease UnitTourcoing HospitalTourcoing cedexFrance
  2. 2.Department of BiostatisticsCentre Hospitalier Régional Universitaire de LilleLilleFrance

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