Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit

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• dc.contributor.author Martín Cerezuela, María
• dc.contributor.author Aseginolaza Lizarazu, Maialen
• dc.contributor.author Boronat García, Patricia
• dc.contributor.author Asensio Martín, María José
• dc.contributor.author Alamán Laguarda, Gisela
• dc.contributor.author Álvarez Lerma, Francisco
• dc.contributor.author Roa Alonso, David
• dc.contributor.author Socias, Lorenzo
• dc.contributor.author Vera Artázcoz, Paula
• dc.contributor.author Ramírez Galleymore, Paula
• dc.contributor.author Grupo de Trabajo en Infección y Sepsis (GTEIS)
• dc.date.accessioned 2024-02-12T08:03:11Z
• dc.date.available 2024-02-12T08:03:11Z
• dc.date.issued 2023
• dc.description.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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Martín-Cerezuela M, Aseginolaza-Lizarazu M, Boronat-García P, Asensio-Martín MJ, Alamán-Laguarda G, Álvarez-Lerma F, et al. Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit. Crit Care. 2023 Feb 23;27(1):72.
• dc.identifier.doi http://dx.doi.org/10.1186/s13054-023-04347-3
• dc.identifier.issn 1364-8535
• dc.identifier.uri http://hdl.handle.net/10230/59074
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof Crit Care. 2023 Feb 23;27(1):72. DOI: 10.1186/s13054-02
• dc.rights © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0
• dc.subject.keyword Meningitis
• dc.subject.keyword Streptococcus pneumoniae
• dc.subject.keyword Intensive care units
• dc.subject.keyword Critically illness
• dc.title Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion