Trends in bacterial, mycobacterial, and fungal meningitis in England and Wales 2004–11: an observational study

Okike, Ifeanyichukwu; Ribeiro, Sonia; Ramsay, Mary; Heath, Paul T; Sharland, Mike; Ladhani, Shamez

doi:10.1016/s1473-3099(13)70332-3

Cited by 120 publications

(98 citation statements)

References 14 publications

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“…Bacterial meningitis from pneumococcal, meningococcal, or haemophilus infection has declined after the introduction of vaccination programmes. 28 However, the incidence of pneumonia showed a slight increase over time, consistent with previous studies based on hospital admissions. 29 30 Reducing the proportion of RTI consultations with antibiotics prescribed by 10% is expected to be accompanied by some 2000 fewer antibiotic prescriptions for each practice over 10 years.…”

Section: Discussionsupporting

confidence: 89%

“…These estimates must be viewed in the context of quantitatively important declining secular trends in incidence for several infective complications of RTI, including peritonsillar abscess, mastoiditis, and meningitis. Bacterial meningitis from pneumococcal, meningococcal, or haemophilus infection has declined after the introduction of vaccination programmes 28. However, the incidence of pneumonia showed a slight increase over time, consistent with previous studies based on hospital admissions 29…”

Section: Discussionsupporting

confidence: 86%

See 1 more Smart Citation

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Gulliford

Moore

Little

et al. 2016

BMJ

120

114

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Objective To determine whether the incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome is higher in general practices that prescribe fewer antibiotics for self limiting respiratory tract infections (RTIs).Design Cohort study.Setting 610 UK general practices from the UK Clinical Practice Research Datalink.Participants Registered patients with 45.5 million person years of follow-up from 2005 to 2014.Exposures Standardised proportion of RTI consultations with antibiotics prescribed for each general practice, and rate of antibiotic prescriptions for RTIs per 1000 registered patients.Main outcome measures Incidence of pneumonia, peritonsillar abscess, mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome, adjusting for age group, sex, region, deprivation fifth, RTI consultation rate, and general practice.Results From 2005 to 2014 the proportion of RTI consultations with antibiotics prescribed decreased from 53.9% to 50.5% in men and from 54.5% to 51.5% in women. From 2005 to 2014, new episodes of meningitis, mastoiditis, and peritonsillar abscess decreased annually by 5.3%, 4.6%, and 1.0%, respectively, whereas new episodes of pneumonia increased by 0.4%. Age and sex standardised incidences for pneumonia and peritonsillar abscess were higher for practices in the lowest fourth of antibiotic prescribing compared with the highest fourth. The adjusted relative risk increases for a 10% reduction in antibiotic prescribing were 12.8% (95% confidence interval 7.8% to 17.5%, P<0.001) for pneumonia and 9.9% (5.6% to 14.0%, P<0.001) for peritonsillar abscess. If a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then it might observe 1.1 (95% confidence interval 0.6 to 1.5) more cases of pneumonia each year and 0.9 (0.5 to 1.3) more cases of peritonsillar abscess each decade. Mastoiditis, empyema, meningitis, intracranial abscess, and Lemierre’s syndrome were similar in frequency at low prescribing and high prescribing practices.Conclusions General practices that adopt a policy to reduce antibiotic prescribing for RTIs might expect a slight increase in the incidence of treatable pneumonia and peritonsillar abscess. No increase is likely in mastoiditis, empyema, bacterial meningitis, intracranial abscess, or Lemierre’s syndrome. Even a substantial reduction in antibiotic prescribing was predicted to be associated with only a small increase in numbers of cases observed overall, but caution might be required in subgroups at higher risk of pneumonia.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 86%

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Gulliford

Moore

Little

et al. 2016

BMJ

120

114

View full text Add to dashboard Cite

show abstract

“…S. pneumoniae was the most common cause of bacterial meningitis (58.0%), followed by Streptococcus agalactiae (group B streptococcus) (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and Listeria monocytogenes (3.4%). Staphylococcus aureus and Escherichia coli are also important causes of bacterial meningitis (15), and Streptococcus suis is emerging as a zoonotic etiology of meningitis (16); however, it must be noted that meningitis can be caused by a plethora of different bacteria (17). The most common alternative bacterial cause of meningitis is Mycobacterium tuberculosis, which is recognized particularly in pediatric populations of the developing world (18,19).…”

Section: Meningitismentioning

confidence: 99%

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

et al. 2014

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SUMMARY The brain is well protected against microbial invasion by cellular barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB). In addition, cells within the central nervous system (CNS) are capable of producing an immune response against invading pathogens. Nonetheless, a range of pathogenic microbes make their way to the CNS, and the resulting infections can cause significant morbidity and mortality. Bacteria, amoebae, fungi, and viruses are capable of CNS invasion, with the latter using axonal transport as a common route of infection. In this review, we compare the mechanisms by which bacterial pathogens reach the CNS and infect the brain. In particular, we focus on recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.

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“…The annual incidence of fungal meningitis in the UK, based on a recent epidemiological study, was 0.09 per 100 000 people (95% CI 0.08 to 0.10), and remained stable between 2004 and 2011. The median age at diagnosis is 40.4 years (IQR 29.3–51.1) 1. There is little clinical literature relating to fungal spinal cord of spinal meningeal infection in the absence of osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

Intradural extramedullary spinal candida infection

et al. 2015

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Trends in bacterial, mycobacterial, and fungal meningitis in England and Wales 2004–11: an observational study

Cited by 120 publications

References 14 publications

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

Intradural extramedullary spinal candida infection

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