Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors

Lu, Cheng-Hsien; Huang, Chi-Ren; Chang, Wen-Neng; Chang, Chin-Jung; Cheng, Ben-Chung; Lee, Ping-Yu; Lin, Mei-Wen; Chang, Hsueh‐Wen

doi:10.1016/s0303-8467(02)00052-5

Cited by 81 publications

(42 citation statements)

References 20 publications

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“…[1][2][3][4] Given that bacterial meningitis freqently has associated poor outcomes, new treatment strategies are needed. Of particular interest is therapeutic hypothermia (TH).…”

Section: Introductionmentioning

confidence: 99%

Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?

Lepur

Kutleša

Baršić

2011

Journal of Infection

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“…[1][2][3][4] Given that bacterial meningitis freqently has associated poor outcomes, new treatment strategies are needed. Of particular interest is therapeutic hypothermia (TH).…”

Section: Introductionmentioning

confidence: 99%

Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?

Lepur

Kutleša

Baršić

2011

Journal of Infection

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“…Retrospective cohort studies of patients with communityacquired bacterial meningitis have shown an increase in adverse outcomes when initiation of antimicrobial therapy is delayed following the initial visit to a physician or the emergency room (ER) [7]. This data is supported by 2 additional retrospective studies showing improved outcomes and decreased mortality in patients that receive antimicrobial therapy earlier in the course of the disease [8,9]. The data is similar in patients with herpes simplex virus (HSV) encephalitis.…”

Section: Initial Clinical Presentationmentioning

confidence: 90%

Neuro-Intensive Care of Patients with Acute CNS Infections

Beckham

Tyler

2012

Neurotherapeutics

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Summary Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.

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“…This is particularly true with pneumococcal meningitis [1][2][3][4]. The most common factors associated with poor outcome in bacterial meningitis are seizures, advanced age, disturbed consciousness, the presence of multiple organ dysfunction, hypotension, APACHE II score > 13, pneumococcal etiology and delay in antimicrobial treatment [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prospective observational cohort study of cerebrovascular CO2 reactivity in patients with inflammatory CNS diseases

Lepur

Kutleša

Baršić

2011

Eur J Clin Microbiol Infect Dis

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Word count of the text: 3089Word count of the abstract: 258 Conflict of interest: noneThere was no financial support for this study. 2 ABSTRACT PURPOSEThe purpose of this study was to evaluate the significance of cerebrovascular CO 2 reactivity (CO 2 R) in the course and outcome of inflammatory CNS diseases. METHODSSixty eight patients with inflammatory CNS diseases and thirty healthy volunteers were included in this prospective observational cohort study. The observational period was between January 2005 and May 2009. CO 2 reactivity was measured by Transcranial Doppler ultrasound (TCD) using the breath-holding method. We compared patients with normal CO 2 R (BHI m ≥ 1.18 = BHI N group) with patients who showed impaired CO 2 R (BHI m < 1.18 = BHI R group). We also analyzed the association of impaired CO 2 R with the etiology, severity and outcome of disease. RESULTSWhen compared to BHI N group, the patients from BHI R group were older, had a heavier consciousness disturbance, experienced more frequent respiratory failure, and subsequently had worse outcomes. There were no fatalities among the 28 patients in the BHI N group. The comparison of subjects with bacterial and non-bacterial meningitis revealed no significant differences. The unfavorable outcome of disease (GOS 1-3) was significantly more common in subjects with impaired CO 2 reactivity (62.5% vs. 10.7%).Logistic regression analysis was performed in order to establish the prognostic value of BHI m . The outcome variable was unfavorable outcome (GOS 1-3), while the independent variables were age, GCS and BHI m . The age and BHI m showed the strongest influence on disease outcome. A decrease of BHI m for each 0,1 unit increased the risk of unfavorable outcome for 17%. CONCLUSIONSOur study emphasizes the importance of CO 2 reactivity assessment in patients with inflammatory CNS diseases.

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Community-acquired bacterial meningitis in adults: the epidemiology, timing of appropriate antimicrobial therapy, and prognostic factors

Cited by 81 publications

References 20 publications

Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?

Induced hypothermia in adult community-acquired bacterial meningitis – more than just a possibility?

Neuro-Intensive Care of Patients with Acute CNS Infections

Prospective observational cohort study of cerebrovascular CO2 reactivity in patients with inflammatory CNS diseases

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