Adjunctive dexamethasone treatment in adults with listeria monocytogenes meningitis: a prospective nationwide cohort study

Brouwer, Matthijs C.; Beek, Diederik van de

doi:10.1016/j.eclinm.2023.101922

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…Adjunctive steroids are recommended and should be started as soon as possible if bacterial meningitis is suspected. A recent study conducted in the Netherlands analyzed a cohort of 162 cases of neurolisteriosis spanning a period of 17 years [18 ▪▪ ]. The findings of this study indicated that administering DXM promptly to patients with neurolisteriosis resulted in a better outcome.…”

Section: Controversies On Management Of Meningoencephalitismentioning

confidence: 81%

“…Meningococcal meningitis is also rare (3%) but with less morbidity and mortality, with up to 18% of patients with a modified Rankin score at least 3 at 3 months [1 ▪▪ ] and 14% with a Glasgow outcome scale 4 or less in a Dutch cohort, driven by an outbreak of serogroup W associated with higher rates of unfavorable outcome [17 ▪▪ ]. Neurological listeriosis is a rare cause (2%) but is associated with high morbidity and mortality, with up to 57% of patients with a modified Rankin score at least 3 at 3 months [1 ▪▪ ] and 56% with a Glasgow outcome scale 4 or less [18 ▪▪ ].…”

Section: Bacterial Causesmentioning

confidence: 99%

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Severe meningoencephalitis: epidemiology and outcomes

Thy,

de Montmollin,

Bouadma

et al. 2023

Current Opinion in Critical Care

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Purpose of review This article aims to provide an updated review on the epidemiology and outcomes of severe meningoencephalitis. Recent findings Meningoencephalitis is a critical medical condition characterized by inflammation in both the meninges and brain parenchyma. Bacterial, viral, or fungal infections are common causes, although noninfectious factors, such as autoimmune causes, can also contribute. In patients requiring intensive care, meningoencephalitis is associated with a severe prognosis, including mortality rates ranging from 11 to 25% and functional disability in 15–25% of survivors. Recent multicenter studies have identified several parameters linked to poor outcomes, including older age, immunocompromised status, focal neurologic signs, abnormal brain imaging, and delayed administration of antimicrobials. The use of new multiplex PCR techniques for diagnosis has generated debate based on recent data. Investigation is still needed to determine the effectiveness of adjunctive therapies, including seizure prophylaxis, and adjunctive steroids for nonbacterial causes. Summary Recent multicenter studies have enhanced our understanding of the current epidemiology and outcomes of severe meningoencephalitis in adult patients.

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Section: Controversies On Management Of Meningoencephalitismentioning

confidence: 81%

Section: Bacterial Causesmentioning

confidence: 99%

Severe meningoencephalitis: epidemiology and outcomes

Thy,

de Montmollin,

Bouadma

et al. 2023

Current Opinion in Critical Care

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“…Despite adequate antibiotic therapy and advances in supportive therapies, bacterial meningitis remains associated with high mortality and morbidity rates [ 46 ]. In particular, the risk of mortality and neurological sequelae in survivors is high, especially in patients with pneumococcal and Listeria monocytogenes meningitis [ 47 , 48 ]. In the last year, it became clear that bacterial lysis due to antibiotic treatment and the subsequent inflammatory response played a pivotal role in the development of organ dysfunction [ 47 ].…”

Section: Methodsmentioning

confidence: 99%

Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23

Girardis,

Coloretti,

Antonelli

et al. 2024

J Anesth Analg Crit Care

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Background In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies. Methods A panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method. Results The consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions. Conclusions Although clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.

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“…Det er ikke overraskende, da denne behandling tidligere er dokumenteret at kunne reducere mortaliteten ved meningitis -formentlig gennem en effekt på neuroinflammation og på systemiske komplikationer [4]. Men forventeligt skal de nuvaerende retningslinjer justeres, så endnu flere patienter med bakteriel meningitis vil få adjuverende steroidbehandling -uafhaengigt af starttidspunktet for antibiotisk behandling og bakteriel årsag [5] -ligesom risikoprofilen ved steroidbehandling hos intensiv behandlingskraevende patienter er minimal.…”

Section: Anbefalingerne I Artiklen [1] Er I Vid Udstraekning Translat...unclassified

Begrænset evidens af nye behandlingstiltag ved bakteriel meningitis

Brandt,

Andersen

2024

Ugeskr Læger

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Adjunctive dexamethasone treatment in adults with listeria monocytogenes meningitis: a prospective nationwide cohort study

Cited by 13 publications

References 30 publications

Severe meningoencephalitis: epidemiology and outcomes

Severe meningoencephalitis: epidemiology and outcomes

Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23

Begrænset evidens af nye behandlingstiltag ved bakteriel meningitis

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