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Multicenter Study Observational Study
Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit.
- María Martín-Cerezuela, Maialen Aseginolaza-Lizarazu, Patricia Boronat-García, María José Asensio-Martín, Gisela Alamán-Laguarda, Francisco Álvarez-Lerma, David Roa-Alonso, Lorenzo Socias, Paula Vera-Artázcoz, Paula Ramírez-Galleymore, and Grupo de Trabajo en Infección y Sepsis (GTEIS) from the Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC).
- Intensive Care Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- Crit Care. 2023 Feb 23; 27 (1): 7272.
BackgroundSevere 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.MethodsThis 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.ResultsIn 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%).ConclusionsMortality 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.© 2023. The Author(s).
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