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Predictors of inferior outcome in community acquired bacterial meningitis
A Streharova1, V Krcmery, P Kisac
1St. Elizabeth University Tropical Projects, Slovakia, Slovakia.
Abstract:
The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).
Insights
Community-acquired bacterial meningitis poses significant risks. Trauma, alcohol abuse, diabetes, and specific bacterial types like S. aureus and gram-negative bacteria predict worse outcomes and mortality.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Medicine
Background:
- Community-acquired meningitis remains a significant cause of mortality and morbidity.
- Identifying risk factors for poor outcomes is crucial for effective management.
Purpose of the Study:
- To assess mortality and sequelae in community-acquired meningitis cases.
- To identify risk factors associated with adverse outcomes.
Main Methods:
- Nationwide survey data on community-acquired meningitis.
- Univariate analysis (chi-squared or t-test) to analyze risk factors.
- Comparison of patients with adverse outcomes (death, neurologic sequelae) to all patients.
Main Results:
- Trauma, alcohol abuse, diabetes, Staphylococcus aureus, and gram-negative etiologies predicted inferior outcomes.
- Prior sepsis and gram-negative etiology predicted treatment failure.
- Diabetes, alcoholism, staphylococcal, and gram-negative etiologies predicted mortality; Neisseria meningitidis showed fewer failures.
Conclusions:
- Specific patient factors (trauma, alcohol abuse, diabetes) and bacterial types (S. aureus, gram-negative) are significant predictors of poor outcomes in community-acquired bacterial meningitis.
- Prompt and appropriate initial antibiotic therapy, particularly for Neisseria meningitidis, may reduce treatment failures.
- Neurologic sequelae are more common with alcohol abuse and craniocerebral trauma but less common with pneumococcal etiology.
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