Dramatic reduction of mortality in pneumococcal meningitis

Abstract

BackgroundAcute bacterial meningitis is still a life threatening disease.MethodsWe performed a retrospective observational study on the clinical characteristics of consecutively admitted patients with acute pneumococcal meningitis in a single tertiary care center in central Europe (from 2003 until 2015). Data were compared with a previously published historical group of 87 patients treated for pneumococcal meningitis at the same hospital (from 1984 until 2002).ResultsFifty-five consecutive patients with microbiologically proven pneumococcal meningitis were included. Most striking, mortality was down to 5.5 %, which was significantly lower than in the historical group where 24.1 % of the patients did not survive. Intracranial complications during the course of the disease were common and affected half of the patients. Unlike in the historic group, most of the intracranial complications (except ischemic stroke) were no longer associated with a low Glasgow Outcome Score at discharge.ConclusionThe drastic reduction of mortality proves there have been important advances in the treatment of pneumococcal meningitis. Nevertheless, the fact that only 44.2 % of survivors had a full recovery indicates that the search for new adjunctive treatment options must be ongoing.

Sex‐based differences in the response to dexamethasone in bacterial meningitis: Analysis of the European dexamethasone in adulthood bacterial meningitis study

“…By contrast, in the intervening years, the relative contribution of pneumococcal cases to adult bacterial meningitis has increased, and affected patients are older and more likely to be immunocompromised; treatment options, including intensive care medicine, have also improved, as has the overall outcome, and therefore the possibility that subgroup analyses of older data may not accurately reflect differences between men and women in the current patient population is a potential limitation.…”

Acute bacterial meningitis and stroke

“…After the implementation of dexamethasone as the standard treatment in ABM throughout the Dutch healthcare system, they observed a 15% decrease in neurological adverse effects, a 10% decrease in deaths, an 11% increase in rate of no or minor disability, an 11% decrease in cranial nerve palsy, and a 10% decrease in hearing impairments [10]. A single centre study found that after initiation of corticosteroids, mortality fell from 24.1% to 5.5% [8]. In a 2015 Cochrane review, corticosteroids were found to reduce hearing loss in children with Haemophilus influenzae and mortality in those with PM [9].…”

“…Prior to incorporating corticosteroids into acute treatment regimens, mortality was from 19% to 24%, and serious morbidity 34% to 52% [5][6][7]. Even with contemporary treatment plans, mortality remains as high as 20% in some reports [8][9][10]. One particular adverse effect of ABM is cerebral ischaemia (CI), which is both an indicator of ABM disease severity, and an independent predictor of a poor clinical outcome.…”

Bacterial isolates from CSF sample and their antimicrobial resistance patters in among under-five children suspected for meningitis in Dilla University Referral Hospital

“…Bacterial meningitis is medical emergency that requires immediate medical attention (7,8). Even with appropriate treatment, morbidity and mortality can be substantial (9,10).…”