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Meningitis in critically ill patients admitted to intensive care unit for severe community-acquired pneumococcal
Paul Jaubert1, Julien Charpentier1, Sarah Benghanem1,2
1Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
Background:
Although it has been reported that patients with pneumococcal pneumonia may develop meningitis, lumbar puncture is not systematically recommended in these patients, even in patients with associated bacteremia or invasive pneumococcal disease. The aim of this study was to determine the characteristics and outcomes of patients admitted to intensive care unit (ICU) for pneumococcal community-acquired pneumonia who developed meningitis.
Methods:
We retrospectively included all consecutive patients admitted to our ICU from January 2006 to December 2020 for severe pneumococcal community-acquired pneumonia according to American Thoracic Society criteria. Meningitis was defined as pleocytosis > 5 cells/mm3 or a positive culture of cerebrospinal fluid for Streptococcus pneumoniae in lumbar puncture. The primary endpoint was the proportion of patients with meningitis during their ICU stay.
Results:
Overall, 262 patients [64(52-75) years old] were included: 154(59%) were male, 80(30%) had chronic respiratory disease, 105(39%) were immunocompromised and 6(2%) were vaccinated against S. pneumoniae. A lumbar puncture was performed in 88(34%) patients with a delay from ICU admission to puncture lumbar of 10.5 (2.8-24.1) h and after the initiation of pneumococcal antibiotherapy in 81(92%) patients. Meningitis was diagnosed in 14 patients: 16% of patients with lumbar puncture and 5% of patients in the whole population. Patients with meningitis had more frequently human immunodeficiency virus positive status (29 vs. 5%, p = 0.02), neurological deficits on ICU admission (43 vs. 16%, p = 0.03) and pneumococcal bacteremia (71 vs. 30%, p < 0.01) than those without. The ICU mortality rate (14 vs. 13%, p = 0.73) and the mortality rate at Day-90 (21 vs. 15%, p = 0.83) did not differ between patients with and without meningitis. The proportion of patients with neurological disorders at ICU discharge was higher in patients with meningitis (64 vs. 23%, p < 0.001) than in those without. The other outcomes did not differ at ICU discharge, Day-30 and Day-90 between the two groups of patients.
Conclusion:
Meningitis was diagnosed in 16% of patients with severe pneumococcal community-acquired pneumonia in whom a lumbar puncture was performed, was more frequent in patients with pneumococcal bacteremia and was associated with more frequent neurological disorders at ICU discharge. Further studies are needed to confirm these results.
Insights
Pneumococcal pneumonia patients who underwent lumbar puncture had a 16% meningitis rate, particularly those with bacteremia. Meningitis was linked to more neurological issues at discharge, though mortality rates were similar.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Pneumococcal pneumonia can lead to meningitis, but lumbar puncture is not routinely performed.
- This study investigates the characteristics and outcomes of ICU patients with pneumococcal pneumonia who developed meningitis.
Purpose of the Study:
- To determine the incidence of meningitis in intensive care unit (ICU) patients with severe pneumococcal community-acquired pneumonia.
- To identify risk factors and outcomes associated with meningitis in this patient population.
Main Methods:
- Retrospective analysis of 262 patients admitted to the ICU for severe pneumococcal community-acquired pneumonia (2006-2020).
- Meningitis defined by cerebrospinal fluid analysis (pleocytosis >5 cells/mm³ or positive S. pneumoniae culture).
- Comparison of clinical characteristics and outcomes between patients with and without meningitis.
Main Results:
- Meningitis was diagnosed in 16% of patients who underwent lumbar puncture (5% of the total cohort).
- Patients with meningitis were more likely to have HIV, neurological deficits on admission, and pneumococcal bacteremia.
- Neurological disorders at ICU discharge were significantly higher in patients with meningitis (64% vs. 23%).
Conclusions:
- Meningitis occurs in a notable proportion of severe pneumococcal pneumonia patients undergoing lumbar puncture.
- Pneumococcal bacteremia is associated with a higher risk of meningitis.
- Meningitis is linked to increased neurological complications post-ICU stay, necessitating further investigation.
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