Dramatic reduction of mortality in pneumococcal meningitis

Critical Care, Oct 2016

Background Acute bacterial meningitis is still a life threatening disease. Methods We performed a retrospective observational study on the clinical characteristics of consecutively admitted patients with acute pneumococcal meningitis in a single tertiary care center in central Europe (from 2003 until 2015). Data were compared with a previously published historical group of 87 patients treated for pneumococcal meningitis at the same hospital (from 1984 until 2002). Results Fifty-five consecutive patients with microbiologically proven pneumococcal meningitis were included. Most striking, mortality was down to 5.5 %, which was significantly lower than in the historical group where 24.1 % of the patients did not survive. Intracranial complications during the course of the disease were common and affected half of the patients. Unlike in the historic group, most of the intracranial complications (except ischemic stroke) were no longer associated with a low Glasgow Outcome Score at discharge. Conclusion The drastic reduction of mortality proves there have been important advances in the treatment of pneumococcal meningitis. Nevertheless, the fact that only 44.2 % of survivors had a full recovery indicates that the search for new adjunctive treatment options must be ongoing.

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Dramatic reduction of mortality in pneumococcal meningitis

Buchholz et al. Critical Care Dramatic reduction of mortality in pneumococcal meningitis Grete Buchholz 1 3 Uwe Koedel 1 3 Hans-Walter Pfister 1 3 Stefan Kastenbauer 1 2 Matthias Klein 0 1 0 Emergency Department, Klinikum Grosshadern, Ludwig Maximilians University , Marchioninistr, 15, 81377 Munich , Germany 1 Methods All inpatients suffering from bacterial meningitis and treated at the Neurological Department of the University of Munich from 2003 to 2015 were identified. The 2 Praxis für Neurologie , Destouchesstrasse 73, 80796 Munich , Germany 3 Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University , Marchioninistr. 15, 81377, Munich , Germany Background: Acute bacterial meningitis is still a life threatening disease. Methods: We performed a retrospective observational study on the clinical characteristics of consecutively admitted patients with acute pneumococcal meningitis in a single tertiary care center in central Europe (from 2003 until 2015). Data were compared with a previously published historical group of 87 patients treated for pneumococcal meningitis at the same hospital (from 1984 until 2002). Results: Fifty-five consecutive patients with microbiologically proven pneumococcal meningitis were included. Most striking, mortality was down to 5.5 %, which was significantly lower than in the historical group where 24.1 % of the patients did not survive. Intracranial complications during the course of the disease were common and affected half of the patients. Unlike in the historic group, most of the intracranial complications (except ischemic stroke) were no longer associated with a low Glasgow Outcome Score at discharge. Conclusion: The drastic reduction of mortality proves there have been important advances in the treatment of pneumococcal meningitis. Nevertheless, the fact that only 44.2 % of survivors had a full recovery indicates that the search for new adjunctive treatment options must be ongoing. Bacterial meningitis; Pneumococcal meningitis; Neurocritical care; CNS infection; Streptococcus pneumoniae; Intracranial complications - Background Streptococcus pneumoniae is not only the most frequent but also one of the most threatening pathogens causing acute bacterial meningitis. Fatality rates are still high, and up to 17 % of patients die [1, 2]. Patients surviving pneumococcal meningitis often suffer from long-term neurological sequelae such as impaired neuropsychological abilities or focal neurological deficits ranging from cranial nerve palsy to hemiparesis [3–5]. Frequently, those sequelae are consequences of intracranial complications occurring during the course of the disease, such as intracranial hemorrhage, brain edema, cerebritis, empyema, sinus thrombosis, cerebral ischemia and others. Moreover, potentially fatal systemic complications such as septic shock, intravasal coagulation, acute respiratory distress syndrome and others occur frequently [6]. In a previous study from our center, 87 cases of patients suffering from pneumococcal meningitis from 1984 until 2002 were analyzed. The reported in-hospital mortality rate in that study period was 24 %. Among the patients, 75 % suffered from intracranial complications with brain edema being the most frequent (29 %), followed by hydrocephalus (16 %), arterial complications (22 %) and venous cerebrovascular complications (9 %). Only 48 % of patients had a good clinical outcome defined by a Glasgow Outcome Scale (GOS) of 5 [3]. We have since reviewed the patients’ records from the previous study to assess the current characteristics of medical care and outcome in patients with pneumococcal meningitis, beginning in 2003 and leading up to today. Neurological Department of the University of Munich is part of a tertiary care hospital (Klinikum Grosshadern) in Munich, Germany. A neurologist is present at the emergency department 24 h a day, 7 days a week. This neurologist is not involved in the patient workup as a consultant, but sees all patients with a presumed neurological diagnosis “front line”. In the case of suspected bacterial meningitis, diagnostic workup and empiric therapy are initiated according to national guidelines (steroids were introduced after publication of the Dutch dexamethasone study [7–9]). All patients received cerebral imaging (usually cerebral computed tomography (CCT), except when there were contraindications such as suspected pregnancy), before admission to the ward to check for (i) intracranial complications and (ii) infectious foci. The neurological intensive care unit (NICU) with a capacity for 12 simultaneous patients is run by a team of neurologists and neuro-intensivists with a focus on the treatment of patients with life-threatening neurological diseases: more than 95 % of the patients primarily suffer from a neurologic disease (admission diagnosis). One main focus of the center is treatment of infectious diseases of the brain [10]. All patients with bacterial meningitis recei (...truncated)


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Grete Buchholz, Uwe Koedel, Hans-Walter Pfister, Stefan Kastenbauer, Matthias Klein. Dramatic reduction of mortality in pneumococcal meningitis, Critical Care, 2016, pp. 312, 20, DOI: 10.1186/s13054-016-1498-8