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Therapeutic hypothermia for adult community-acquired bacterial meningitis-historical control study

Marko Kutleša1, Dragan Lepur2, Bruno Baršić1

  • 1University of Zagreb, School of Medicine, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Department of Intensive Care Medicine and Neuroinfectology, Zagreb, Croatia.

Clinical Neurology and Neurosurgery
|July 2, 2014
PubMed

Insights

Therapeutic hypothermia significantly reduces mortality and improves neurological recovery in severe community-acquired bacterial meningitis (CABM). This study shows hypothermia is an effective treatment for CABM patients with poor prognosis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Community-acquired bacterial meningitis (CABM) remains a significant cause of mortality and severe neurological deficits.
  • Current antibiotic therapies and critical care interventions have limitations in improving outcomes for severe CABM cases.

Purpose of the Study:

  • To evaluate the efficacy of therapeutic hypothermia (TH) as a treatment for patients diagnosed with severe community-acquired bacterial meningitis (CABM).

Main Methods:

  • A cohort of 41 patients with CABM treated with TH (January 2009-January 2013) was compared to 90 historical controls (1994-2008).
  • TH was indicated for patients with Glasgow Coma Scale (GCS) ≤9 and respiratory failure, with specific criteria involving breath holding index or optic nerve sheath diameter.
  • Outcomes measured included mortality and neurological recovery using the Glasgow Outcome Scale (GOS).

Main Results:

  • Patients treated with TH exhibited significantly lower hospital mortality rates (19.5% vs. 48.9%, p=0.002).
  • Adverse neurological outcomes (GOS 1-3) were also significantly reduced in the TH group (43.9% vs. 65.6%, p=0.023).
  • Multivariate analysis confirmed TH's positive impact on mortality (OR=0.059) and neurological outcome (OR=0.209), independent of other risk factors.

Conclusions:

  • Therapeutic hypothermia represents a novel and effective therapeutic strategy for severe community-acquired bacterial meningitis.
  • Implementing TH can significantly improve patient outcomes, reducing both mortality and long-term neurological impairment in severe CABM.
Abstract

Keywords:
Bacterial meningitisClinical outcomeTherapeutic hypothermia

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