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Bacterial meningitis in alcoholic patients: A population-based prospective study
Kiril E B van Veen1, Matthijs C Brouwer2, Arie van der Ende3
1Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
Objectives:
To study clinical features and outcome of community-acquired bacterial meningitis in alcoholic patients.
Methods:
Patients with a history of alcoholism were selected from our nationwide, prospective cohort on community-acquired bacterial meningitis performed from March 2006 to October 2014. Data on patient history, symptoms and signs on admission, treatment, and outcome were prospectively collected.
Results:
Of 1359 included episodes, 88 episodes (6%) occurred in 88 alcoholic patients. Seizures as presenting symptom were present in 18% alcoholic patients, and 23% presented with co-existing pneumonia. Causative organisms were Streptococcus pneumoniae in 76%, Listeria monocytogenes in 8%, and Neisseria meningitidis in 6% of patients. A high rate of systemic complications occurred with respiratory failure in 40% and endocarditis in 9% of patients. Outcome was unfavorable in 58% of alcoholic patients, and 25% died. Alcoholism was associated with unfavorable outcome in a multivariate analysis (OR 1.96; 95% CI 1.12-3.46; P = 0.019), but not with death (OR 0.76; 95% CI 0.35-1.68; P = 0.762).
Conclusion:
Alcoholic bacterial meningitis patients often have an unfavorable outcome, which appears to result from a high rate of systemic complications, mainly respiratory failure. Seizures are common in alcoholic patients and warrant caution of development of an alcohol withdrawal syndrome.
Insights
Community-acquired bacterial meningitis in alcoholic patients often leads to poor outcomes due to systemic complications like respiratory failure. Seizures are common, signaling potential alcohol withdrawal syndrome.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Community-acquired bacterial meningitis (CABM) poses significant health risks.
- Alcoholism is a known risk factor for various infections and complications.
- The specific clinical features and outcomes of CABM in alcoholic patients require detailed investigation.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of community-acquired bacterial meningitis (CABM) specifically in patients with a history of alcoholism.
- To identify factors associated with unfavorable outcomes in alcoholic patients diagnosed with CABM.
Main Methods:
- A nationwide prospective cohort study was conducted from March 2006 to October 2014.
- Data were collected on 1359 episodes of CABM, including 88 episodes in alcoholic patients.
- Information gathered included patient history, admission symptoms/signs, treatment, and patient outcomes.
Main Results:
- Alcoholic patients constituted 6% (88/1359) of the CABM cohort.
- Presenting symptoms included seizures (18%) and pneumonia (23%).
- Common causative organisms were Streptococcus pneumoniae (76%). Systemic complications were frequent, with respiratory failure (40%) and endocarditis (9%). Unfavorable outcomes occurred in 58% of alcoholic patients, with a 25% mortality rate. Alcoholism was linked to unfavorable outcomes (OR 1.96).
Conclusions:
- Alcoholic patients with CABM frequently experience unfavorable outcomes, primarily due to a high incidence of systemic complications, notably respiratory failure.
- The occurrence of seizures in this population necessitates vigilance for alcohol withdrawal syndrome.
- Early recognition and management of complications are crucial for improving patient prognosis.
