Severe community-acquired Streptococcus pneumoniae bacterial meningitis : clinical and prognostic picture from the intensive care unit
Martín-Cerezuela, María (Hospital Universitari i Politècnic La Fe (València))
Aseginolaza-Lizarazu, Maialen (Hospital de Donostia (Sant Sebastià, País Basc))
Boronat-García, Patricia (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Asensio-Martín, María José (Hospital Universitario La Paz (Madrid))
Alamán-Laguarda, Gisela (Hospital Universitari de la Ribera (València))
Álvarez Lerma, Francisco (Institut Hospital del Mar d'Investigacions Mèdiques)
Roa-Alonso, David (Hospital Universitario Severo Ochoa)
Socias, Lorenzo (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Vera-Artazcoz, Paula (Institut d'Investigació Biomèdica Sant Pau)
Ramírez, Paula (Hospital Universitari i Politècnic La Fe (València))
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
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	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. 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. 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%). 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Critically illness ; Intensive care units ; Meningitis ; Streptococcus pneumoniae
Published in:	Critical care, Vol. 27 Núm. 1 (december 2023) , p. 72, ISSN 1466-609X

DOI: 10.1186/s13054-023-04347-3
PMID: 36823625

8 p, 930.0 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles