Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania

Abstract

Background The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM. Methods Our retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis. Results The median patient age was 36 (IQR 24–56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0–90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count <150x10e9/l. Conclusions The most common causative agent of CABM was N. meningitidis, with serotype B clearly dominant. Causative agents did not influence the disease outcome. The strongest risk factors for an unfavorable outcome were older age, pneumonia and a low platelet count. Since the introduction of routine vaccination against meningococcus B for infants in Lithuania in 2018, the national vaccination policy may hopefully contribute to a decrease in the incidence of serogroup B meningococcal disease in the Lithuanian population.

Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland

“…Therefore, it is clear that the absence of the classical triad cannot be used to rule out the possibility of BM. In an older study headache was not reported to be correlated with unfavorable outcome [ 26 ], but with a more recent study [ 37 ] headache was correlated with unfavorable outcome, as was the case also in our study. Therefore, clinicians should pay even more attention to BM patients suffering from headache and not only altered mental status, which may be a sign of a more advanced disease.…”

“…Triad of fever, neck stiffness and altered mental status has been previously reported with 41–59% BM cases [ 37 , 38 ]. In our study, the prevalence of the presentation with this triad was much lower (13.5%).…”

“…The treatment administered after the diagnosis of BM remained highly efficacious due to the lack of resistance of bacteria to the most used antibiotics ceftriaxone and vancomycin, as proved earlier with ceftriaxone [ 37 ].…”

Incidence of Vaccine-Preventable Childhood Diseases in the European Union and in the European Free Trade Association Countries

“…In this country, the most common serotype responsible for the disease was B, infecting mainly young children. However, vaccination against meningitidis B has only been routinely introduced in Lithuania since 2018 [ 27 ].…”

Intensyviosios terapijos reikalingumo įvertinimas pacientams, sergantiems ūminiu bakteriniu meningitu: atvejų aprašymai ir literatūros apžvalga

“…Second, neu ro log i cal con di tion on ad mis sion is not the only fac tor de ter min ing the clin i cal course of acute bac te rial men in gi tis. Fac tors of poor out come in clude older age [5,[23][24][25][26][28][29][30], more spe cif i cally, age ³40 years [24], age >50 years [5], age ³60 years [28], age >65 years [29], age >70 years [26]; comorbidities [16,23,26,28,29]; re duced platelet count [24,29,31]; worse over all clin i cal con di tion as de fined by Sim pli fied Acute Phys i ol ogy Score (SAPS) II [31] or APACHE II [5]; low CSF glu cose lev els [28,32]; low CSF leu ko cyte count [25,26,33]; tachy car dia [33], as well as fac tors show ing se ver ity of dis ease (ev i dence of shock, sep sis, and bacteraemia) [2,24,26,28]. To em phasize the im por tance of other fac tors in ad di tion to neu rolog i cal con di tion to in flu ence the out come of pa tients with bac te rial men in gi tis, Weisfelt et al, 2008 [33] are worth not ing.…”