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Klebsiella pneumoniae meningitis: prognostic factors
Abstract:
All 42 cases of Klebsiella pneumoniae meningitis diagnosed between 1981 and 1991 were evaluated. These accounted for 13% of patients with blood and/or cerebrospinal fluid culture-proven bacterial meningitis. There was an increased incidence of K. pneumoniae meningitis from the first 6 years of study (7%) to the last 5 years (16%). K. pneumoniae became increasingly important not only in community-acquired meningitis but also in nosocomial meningitis. 12/13 nosocomial cases were patients who had undergone neurosurgical procedures. The overall mortality rate was 43%. The mortality rate in patients with spontaneous meningitis was higher than that in patients with post-traumatic or postoperative meningitis. Factors that adversely affected mortality were age over 60, diabetes mellitus, and severe neurological deficits on admission. The use of third-generation cephalosporins did not reduce the mortality rate.
Insights
Klebsiella pneumoniae meningitis is an increasing threat, accounting for 13% of bacterial meningitis cases. Despite treatment, mortality remains high, especially in older patients with comorbidities.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Klebsiella pneumoniae is a significant cause of bacterial meningitis.
- An increasing incidence of K. pneumoniae meningitis was observed between 1981 and 1991.
- This pathogen is implicated in both community-acquired and nosocomial meningitis.
Purpose of the Study:
- To evaluate the clinical features and outcomes of Klebsiella pneumoniae meningitis.
- To identify trends in the incidence of K. pneumoniae meningitis.
- To determine factors influencing mortality in these patients.
Main Methods:
- Retrospective analysis of 42 cases of Klebsiella pneumoniae meningitis diagnosed between 1981 and 1991.
- Evaluation of patient demographics, clinical presentation, treatment, and outcomes.
- Comparison of incidence rates over two study periods and analysis of mortality factors.
Main Results:
- Klebsiella pneumoniae accounted for 13% of all bacterial meningitis cases.
- Incidence increased from 7% to 16% over the study period.
- Overall mortality was 43%, with higher rates in spontaneous meningitis.
- Advanced age, diabetes, and severe neurological deficits were associated with increased mortality.
- Third-generation cephalosporins did not significantly reduce mortality.
Conclusions:
- Klebsiella pneumoniae meningitis presents a growing challenge with high mortality.
- Risk factors for adverse outcomes include advanced age, diabetes, and neurological deficits.
- Current antibiotic strategies may not be sufficient to improve survival rates.