Acute bacterial meningitis in adults: Predictors of outcome

Abstract

Case fatality ratio and permanent sequelae of acute bacterial meningitis remain high in recent decades. A prospective longitudinal study of adult patients admitted with community acquired acute bacterial meningitis at a tertiary infectious diseases unit aimed to identify predictors of unfavourable outcome - death and sequelae. Anamnestic, clinical and laboratory data and clinical outcome were recorded. From 1997 to 2006, 279 adults (122F, 157M) with a median age of 51 y were admitted with acute bacterial meningitis. Predisposing condition and comorbidity were recorded in 42% and 38% of patients, respectively. Time between symptoms onset and antibiotic treatment ranged from 6 to 160 h. An aetiological agent was identified in 77% of patients: Streptococcus pneumoniae (29%) and Neisseria meningitidis (27%) were the most frequent. 55 patients (20%) died and 63 (23%) had neurological sequelae 6 months after discharge. In multivariate analysis, 7 independent predictors of unfavourable outcome were identified: internal comorbidity, time to treatment >48 h, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology. The results suggest that acute bacterial meningitis remains associated with significant morbidity and mortality. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential for an optimal clinical outcome.

Clinical Features and Independent Prognostic Factors for Acute Bacterial Meningitis in Adults

“…This has been a consistent finding in earlier studies too [2,9,[17][18][19]. It has been shown in a previous study that there is an independent incremental association between delays in administrating antibiotics and mortality from adult ABM [20].…”

“…In our study, 26 patients (6.84%) had seizures which were less than reported in a recent study (17%) [17]. However, in the poor outcome group, the frequency of seizures was 17.6% (6/34 patients).…”

Intracranial malignant lesions correlate with the requirement for a long treatment course in postoperative central nervous system infection

“…Several studies have shown that early diagnosis and treatment can significantly improve the prognosis of bacterial meningitis 24,25. The clinicians involved in this study were fully aware that bacterial meningitis is an important potential postoperative complication and that once PNBM is diagnosed, antibiotic therapy should be administered as soon as possible; this would have effectively improved the prognosis of the patients in this study 26. This may also explain the low mortality rate observed (only one patient died, due to respiratory insufficiency).…”

Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

“…1 Glucose is mainly transported into the CSF by facilitation across the choroid plexus and the ventricular and subarachnoid capillary system while some of it is transported by simple diffusion. Current theories postulate that the pathogenesis of hypoglycorrhachia is multifactorial and includes inhibition of glucose entry into the subarachnoid spaces due to alterations in the blood brain barrier 6 , increased rate of glucose transport across the arachnoid villi, increased glycolysis by leucocytes and bacteria 17 and increased rate of metabolism in the brain and spinal cord.…”