Community-Acquired Bacterial Meningitis: Risk Stratification for Adverse Clinical Outcome and Effect of Antibiotic Timing

Aronin, Steven I.; Peduzzi, Peter; Quagliarello, Vincent

doi:10.7326/0003-4819-129-11_part_1-199812010-00004

Cited by 428 publications

(240 citation statements)

References 39 publications

Supporting

Mentioning

216

Contrasting

Unclassified

Order By: Relevance

“…and to the time of the onset of consciousness disturbance. We recognize that the definitions we used for the timing of appropriate antibiotic therapy are not 13 completely precise and that using hours, instead of days, would have been much more informative. Unfortunately, this is a retrospective study and precise data could not be obtained from the records of many patients.…”

Section: Discussionmentioning

confidence: 99%

“…A large number of survivors suffer from long-term neurological sequelae (4). Various prognostic factors associated with adverse clinical outcome were reported so far (6)(7)(8)(9)12,13).…”

Section: Introductionmentioning

confidence: 99%

“…The most common factors independently associated with unfavorable outcome were APACHE II score >13, hypotension, seizures, obtunded mental state on admission, age over 60 years and pneumococcal etiology (8,9,13,14). It is reasonable to believe that treatment outcome could be improved by timely and appropriate antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Lepur

Baršić

2007

Infection

View full text Add to dashboard Cite

Word count of the abstract: 296 Word count of the text: 2695Key words: bacterial meningitis, adults, risk factors, antibiotic timing, clinical outcome Conflict of interestNone. Authors' contributionsBoth authors planned, wrote, reviewed and revised the article and approved the final version of the manuscript. Dr Lepur was primarily responsible for data collection and basic statistics. Prof Baršić performed advanced statistical tests. 2 ABSTRACT ObjectivesDespite improvements in diagnostic and therapeutic approach to adult patients with bacterial meningitis, the overall mortality rate is still high. The aim of this study was to evaluate antibiotic timing in the course and outcome of bacterial meningitis.. MethodsTwo hundred and eighty six patients with community-acquired bacterial meningitis aged 14 years and more were included in this retrospective cohort study. Observational period was between 1 January 1990 and 31 December 2004. To assess the association of antibiotic timing and disease outcome we analyzed three timing periods (according to the onset of disease, onset of consciousness disturbance and the time of admission to hospital). Analysis was also performed in a subgroup of culture positive meningitis in 176 patients with altered mental status. ResultsUnfavorable outcome was found in 125 (43,7%) patients. In this group, the start of appropriate antibiotic treatment in relation to the onset of first symptoms and particularly to the onset of consciousness disturbance was significantly delayed (p=0,018 and p<0,001 respectively) compared to the favorable group. Logistic regression analysis in a subgroup of culture positive meningitis in patients with altered mental status revealed that early adequate antibiotic treatment related to the onset of overt signs of meningitis was independently associated with favorable outcome (OR= 11,19; 95% CI 4,57; p<0,001). Advanced age, lower GCS and seizures (OR=1.05,OR=1,45 and OR= 3.65, respectively ) were other risk factors of poor outcome. The presence of chronic diseases, pneumococcal etiology and clinical and laboratory variables which are indicators of disease severity (renal and/or liver 3 dysfunction, hypotension and low cerebrospinal fluid glucose) were not confirmed as independent risk factors of poor outcome. ConclusionsOur study emphasizes the importance of early and adequate antibiotic treatment in the management of bacterial meningitis which significantly enhances the chances for favorable outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

“…A large number of survivors suffer from long-term neurological sequelae (4). Various prognostic factors associated with adverse clinical outcome were reported so far (6)(7)(8)(9)12,13).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Community-Acquired Bacterial Meningitis in Adults: Antibiotic Timing in Disease Course and Outcome

Lepur

Baršić

2007

Infection

View full text Add to dashboard Cite

show abstract

“…In the case of suspected bacterial meningitis, the goal is to emergently initiate appropriate empiric antibiotic therapy, based on the age of the patient, the underlying disease status, and cerebrospinal fluid (CSF) Gram stain, if available. Retrospective cohort studies of patients with communityacquired bacterial meningitis have shown an increase in adverse outcomes when initiation of antimicrobial therapy is delayed following the initial visit to a physician or the emergency room (ER) [7]. This data is supported by 2 additional retrospective studies showing improved outcomes and decreased mortality in patients that receive antimicrobial therapy earlier in the course of the disease [8,9].…”

Section: Initial Clinical Presentationmentioning

confidence: 95%

“…A delay in the initiation of antimicrobial therapy can result in poor outcomes. Retrospective studies have shown that the median delay between time of arrival at the emergency department and antibiotic administration was 4 h, and poor outcomes were associated with delayed antimicrobial therapy [7]. Among patients with a worsening condition while waiting in the ER, delay in antimicrobial therapy longer than 6 h after arrival to the ER was associated with increased risk of death [22].…”

Section: Diagnosismentioning

confidence: 99%

Neuro-Intensive Care of Patients with Acute CNS Infections

Beckham

Tyler

2012

Neurotherapeutics

View full text Add to dashboard Cite

Summary Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.

show abstract