Anest. intenziv. Med. 2009;20(6):317-323

Prognostic factors of community-acquired purulent meningitis outcome in adultsIntensive Care Medicine - Original Paper

Džupová Olga^1,*, Rozsypal Hanuš², Beneš Jiří¹

¹ Klinika infekčních nemocí 3. LF UK a FN Na Bulovce, Praha

² III. klinika infekčních a tropických nemocí 1. LF UK, Praha

Objective:
To assess the clinical outcome of acute bacterial meningitis in adults and to identify predictors of unfavourable outcome.

Design:
Prospective longitudinal observational study.
Setting:
Department of infectious diseases, university hospital.

Materials and methods:
The study included patients of ≥ 16 years of age treated for community-acquired bacterial meningitis. Medical history and clinical laboratory data were recorded. Clinical outcome was classified using the Glasgow Outcome Scale (GOS 1-5) and dichotomized to favourable (GOS 5) and unfavourable (GOS 1-4) outcomes. The significance of the prognostic factors was statistically analyzed by univariate and multivariate analysis.

Results:
Between 1997 and 2006, 279 adults (122 women, 157 men) with median age of 51 years were admitted for community-acquired acute bacterial meningitis. Predisposing conditions (a primary focus or disrupted dural barrier) and comorbidities were recorded in 42% and 38% of patients, respectively. Time from symptoms onset to antibiotic treatment start was ≤ 48 hours in 82% of patients. Fifty-five patients (20%) died and 63 (23%) had neurological sequelae. Multivariate analysis revealed these independent predictors of unfavourable outcome: a medical comorbidity, time to treatment > 48 hours, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology.

Conclusion:
The results document the significant case fatality ratio and sequelae rates of acute bacterial meningitis in adults. Among the identified prognostic factors, only time to treatment can be influenced. Early clinical suspicion in a patient with corresponding symptoms should lead to immediate diagnostic testing and start of treatment. This approach is likely to increase the chances of a favourable outcome.

Keywords: acute bacterial meningitis; clinical outcome; case fatality ratio; prognostic factors

Received: May 27, 2009; Accepted: September 16, 2009; Published: December 1, 2009  Show citation