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Subdural empyema in bacterial meningitis.
Kin K Jim1, Matthijs C Brouwer, Arie van der Ende
1Departments of Neurology, and The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Neurology
|November 9, 2012
Summary
Subdural empyema complicates community-acquired bacterial meningitis in 2.7% of adults, often linked to otitis or sinusitis. Streptococcus pneumoniae is the main cause, and neurosurgical intervention is key for severe cases.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Subdural empyema is a rare but serious complication of bacterial meningitis.
- Early recognition and treatment are crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence, management, and outcomes of subdural empyema in adults with community-acquired bacterial meningitis.
- To identify predisposing factors and common causative organisms.
Main Methods:
- Prospective nationwide cohort study in Dutch hospitals from 2006 to 2011.
- Analysis of 1,034 episodes of community-acquired bacterial meningitis.
Main Results:
- Subdural empyema occurred in 2.7% of cases, frequently associated with otitis/sinusitis (75%) and neurological symptoms (82%).
- Streptococcus pneumoniae was the predominant pathogen (93%).
- Unfavorable outcomes were observed in 68% of cases, with neurosurgical evacuation performed in 5 patients with significant midline shift.
Conclusions:
- Subdural empyema should be suspected in meningitis patients with otitis/sinusitis, focal deficits, or seizures.
- Streptococcus pneumoniae is the primary causative agent.
- Neurosurgical intervention is recommended for empyema with midline shift, focal abnormalities, or altered consciousness.
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