Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: The PNEUMOREA prospective multicenter study*

Abstract

Independent of severity at the time of ICU admission, isolation of penicillin-nonsusceptible strains and a delay in antibiotic treatment following admission were predictors of mortality among patients with pneumococcal meningitis.

The essential neurological examination of the unconscious patient in the emergency room

“…Interestingly, testing both for neck stiffness – after careful exclusion of preceding trauma – and the Babinski sign are highly recommended by our experts. This reflects the importance of using highly specific tests (Isaza Jaramillo et al., 2014; Nakao, Jafri, Shah, & Newman, 2014; van de Beek et al., 2004) that recognize conditions requiring prompt initiation of treatment (Auburtin et al., 2006; Möhlenbruch et al., 2014), although mixed results regarding the sensitivity of each sign have been reported (Isaza Jaramillo et al., 2014; Mattle et al., 2011). …”

Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

“…Most of the case reports and case series of brain herniation secondary to meningitis showed change in the level of consciousness before LP (Joffe, 2007). The clinical contraindications of LP are changing levels of consciousness, fixed dilated pupils, fixed eye deviation, posturing, respiratory changes, papilledema, recent seizure or hypertension with bradycardia (Joffe, 2007;Swanson, 2015;Glimaker, 2015;Auburtin et al, 2006). We conclude that the clinical signs and symptoms are the most important indicators in identifying the risk of herniation and deciding when to delay LP.…”

“…There is clear evidence that the brain CT scan before LP leads to a delay in antibiotic administration (Nagra, 2011;Glimaker et al, 2015). The delaying of antibiotic administration for more than 3 hours leads to a poor clinical outcome (Glimaker et al, 2015;Auburtin et al, 2006). Most of the case reports and case series of brain herniation secondary to meningitis showed change in the level of consciousness before LP (Joffe, 2007).…”

“…There is clear evidence that CT scan before LP leads to a delay in antibiotic administration (Nagra, Wee, Short, & Banerjee, 2011;Glimaker, Johansson, Grindborg, Bottai, Lindquist, & Sjolin, 2015). The delaying of antibiotic administration by more than 3 hours leads to a poor clinical outcome (Glimaker et al, 2015;Auburtin et al, 2006).…”

Diagnosis and Treatment of Tuberculous Meningitis

“…Delay Figure 1 Survival curves for adult patients with acute bacterial meningitis according to age (P = 0.007). in starting antibiotic therapy has been advocated as a main factor in ABM-driven mortality [36][37][38][39][40][41][42]. Therefore, a high index of suspicion of ABM is needed in elderly patients with fever and CNS dysfunction to rule out meningeal infection eventually leading to a prompt spinal tap and early starting of empiric antibiotic therapy.…”