Community-acquired pneumonia in patients with bacterial meningitis: a prospective nationwide cohort study

Abstract

Objective: Pneumonia is considered a focus of infection in patients presenting with community-acquired bacterial meningitis but the impact on disease course is unclear. The aim was to study presenting characteristics, clinical course and outcome of meningitis patients with co-existing pneumonia on admission. Methods: We evaluated adult patients with community-acquired bacterial meningitis with pneumonia on admission in a nationwide, prospective cohort performed from March 2006 to June 2017. We performed logistic regression analysis to identify clinical characteristics predictive of pneumonia on admission, and to quantify the effect of pneumonia on outcome. Results: Pneumonia was diagnosed on admission in 315 of 1852 (17%) bacterial meningitis episodes and confirmed by chest X-ray in 256 of 308 (83%) episodes. Streptococcus pneumoniae was the causative organism in 256 of 315 episodes (81%). Pneumonia on admission was associated with advanced age (OR 1.03 per year increase, 95% CI 1.02e1.04, p < 0.001), alcoholism (OR 1.96, 95% CI 1.23e3.14, p 0.004), cancer (OR 1.54, 95% CI 1.12e2.13, p 0.008), absence of otitis or sinusitis (OR 0.44, 95% CI 0.32e0.59, p < 0.001) and S. pneumoniae (OR 2.14, 95% CI 1.55e2.95, p < 0.001) in the multivariate analysis. An unfavourable outcome defined as a score of 1e4 on the Glasgow Outcome Scale was observed in 172 (55%) episodes and 87 patients (28%) died. Pneumonia on admission was independently associated with unfavourable outcome and mortality in the multivariate analysis (OR 1.48, 95% CI 1.12e1.96; p 0.005). Conclusion: Pneumonia on admission in bacterial meningitis is a frequent coexisting infection and is independently associated with unfavourable outcome and mortality.

Recurrent Community-Acquired Bacterial Meningitis in Adults

“…In a disease as deadly as bacterial meningitis, early antibiotic treatment is one of the most important factors for favorable outcome [ 23 ]. Second, patients with recurrent meningitis had a lower rate of bacteremia and systemic complications [ 24 , 25 ]. Episodes are often predisposed by a CSF leakage, which contributes to a better prognosis due to the relatively benign pathophysiology [ 4 ].…”

Gene polymorphisms of TLR10: effects on bacterial meningitis outcomes in Angolan children

“…Overall, it is estimated that 8–19% of patients with community‐acquired BM also experience coexisting pneumonia [3]. These rates vary based on age, underlying disease and the causative pathogen.…”

“…Although vaccinations have decreased the occurrence of BM, 1 to 2 million cases of BM still occur worldwide annually [2]. BM is primarily caused by Streptococcus pneumoniae (S. pneumoniae) , Neisseria meningitides (N. meningitides) and Haemophilus influenzae ( H. influenzae) , usually carried asymptomatically in the human nasopharynx [1, 3]. Transmission can occur through respiratory droplets or saliva [1].…”

“…Transmission can occur through respiratory droplets or saliva [1]. BM is often related to other infections outside the central nervous system (CNS), such as pneumonia, bacteraemia, sinusitis and otitis media [3].…”

Vertebral osteomyelitis in bacterial meningitis patients

“…Despite recent advances in prevention and treatment of acute bacterial meningitis, it remains a life-threatening disease with significant morbidity and mortality (Figueiredo et al, 2018. Patients with bacterial meningitis often present with distant foci of infection, such as otitis, sinusitis, pneumonia, or endocarditis which can either precede or complicate clinical course (Bijlsma Merijn W et al, 2016, Figueiredo et al, 2020, Jim et al, 2012a, 2012b, Lucas et al, 2013.…”