Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit
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Published:2023-02-23
Issue:1
Volume:27
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Martín-Cerezuela María, Aseginolaza-Lizarazu Maialen, Boronat-García Patricia, Asensio-Martín María José, Alamán-Laguarda Gisela, Álvarez-Lerma Francisco, Roa-Alonso David, Socias Lorenzo, Vera-Artázcoz Paula, Ramírez-Galleymore PaulaORCID, Balandin-Moreno Bárbara, Vidaur-Tello Loreto, Sánchez-Morcillo Silvia, Ballesteros-Herráez Juan Carlos, Ossa-Echeverri Sergio, Andaluz-Ojeda David, Blasco-Navalpotro Miguel Ángel, Abella-Álvarez Ana, Nogales-Martín Leonor, Díaz-Santos Emili, Plans-Galván Oriol, Conejo-Márquez Isabel,
Abstract
Abstract
Background
Severe community-acquired pneumococcal meningitis is a medical emergency. The aim of the present investigation was to evaluate the epidemiology, management and outcomes of this condition.
Methods
This was a retrospective, observational and multicenter cohort study. Sixteen Spanish intensive care units (ICUs) were included. Demographic, clinical and microbiological variables from patients with Streptococcus pneumoniae meningitis admitted to ICU were evaluated. Clinical response was evaluated at 72 h after antibiotic treatment initiation, and meningitis complications, length of stay and 30-day mortality were also recorded.
Results
In total, 255 patients were included. Cerebrospinal fluid (CSF) culture was positive in 89.7%; 25.7% were non-susceptible to penicillin, and 5.2% were non-susceptible to ceftriaxone or cefotaxime. The most frequent empiric antibiotic regimen was third-generation cephalosporin (47.5%) plus vancomycin (27.8%) or linezolid (12.9%). A steroid treatment regimen was administered to 88.6% of the patients. Clinical response was achieved in 65.8% of patients after 72 h of antibiotic treatment. Multivariate analysis identified two factors associated with early treatment failure: invasive mechanical ventilation (OR 10.74; 95% CI 3.04–37.95, p < 0.001) and septic shock (OR 1.18; 95% CI 1.03–1.36, p = 0.017). The 30-day mortality rate was 13.7%. Only three factors were independently associated with 30-day mortality: delay in start of antibiotic treatment (OR 18.69; 95% CI 2.13–163.97, p = 0.008), Sepsis-related Organ Failure Assessment (SOFA) score (OR 1.36; 95% CI 1.12–1.66, p = 0.002) and early treatment failure (OR 21.75 (3.40–139.18), p = 0.001). Neurological complications appeared in 124 patients (48.63%).
Conclusions
Mortality rate in critically ill patients with pneumococcal meningitis is lower than previously reported. Delay in antibiotic treatment following admission is the only amendable factor associated with mortality.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
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