Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit
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 Spanis...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04347-3 |
| _version_ | 1797864560100638720 |
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| author | 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 the Grupo de Trabajo en Infección y Sepsis (GTEIS) from the Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC) |
| author_facet | 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 the Grupo de Trabajo en Infección y Sepsis (GTEIS) from the Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC) |
| author_sort | María Martín-Cerezuela |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-09T22:53:51Z |
| format | Article |
| id | doaj.art-66e2c0552c5b458f89985a3e315f95ce |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T22:53:51Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-66e2c0552c5b458f89985a3e315f95ce2023-03-22T11:21:37ZengBMCCritical Care1364-85352023-02-012711810.1186/s13054-023-04347-3Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unitMaría Martín-Cerezuela0Maialen Aseginolaza-Lizarazu1Patricia Boronat-García2María José Asensio-Martín3Gisela Alamán-Laguarda4Francisco Álvarez-Lerma5David Roa-Alonso6Lorenzo Socias7Paula Vera-Artázcoz8Paula Ramírez-Galleymore9the 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 FeIntensive Care Unit, Hospital Donostia-Donostia OspitaleaIntensive Care Unit, Hospital Univeristari Germans Trias i PujolIntensive Care Unit, Hospital Universitario La PazIntensive Care Unit, Hospital Universitario de la RiberaIntensive Care Unit, Fundación, Instituto Hospital del Mar de Investigaciones Médicas (IMIM)Intensive Care Unit, Hospital Severo OchoaIntensive Care Unit, Hospital Son LlàtzerIntensive Care Unit, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant PauIntensive Care Unit, Hospital Universitario y Politécnico La FeAbstract 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.https://doi.org/10.1186/s13054-023-04347-3MeningitisStreptococcus pneumoniaeIntensive care unitsCritically illness |
| spellingShingle | 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 the Grupo de Trabajo en Infección y Sepsis (GTEIS) from the Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC) Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit Critical Care Meningitis Streptococcus pneumoniae Intensive care units Critically illness |
| title | Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit |
| title_full | Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit |
| title_fullStr | Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit |
| title_full_unstemmed | Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit |
| title_short | Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit |
| title_sort | severe community acquired streptococcus pneumoniae bacterial meningitis clinical and prognostic picture from the intensive care unit |
| topic | Meningitis Streptococcus pneumoniae Intensive care units Critically illness |
| url | https://doi.org/10.1186/s13054-023-04347-3 |
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