Effect of the COVID-19 pandemic on clinical characteristics and outcomes of adult pneumococcal meningitis patients – a Dutch prospective nationwide cohort study

Abstract

Purpose To investigate clinical characteristics and outcomes of patients with pneumococcal meningitis during the COVID-19 pandemic. Methods In a Dutch prospective cohort, risk factors and clinical characteristics of pneumococcal meningitis episodes occurring during the COVID-19 pandemic (starting March 2020) were compared with those from baseline and the time afterwards. Outcomes were compared with an age-adjusted logistic regression model. Results We included 1,699 patients in 2006–2020, 50 patients in 2020–2021, and 182 patients in 2021–2023. After March 2020 relatively more alcoholism was reported (2006–2020, 6.1%; 2020–2021, 18%; 2021–2023, 9.7%; P = 0.002) and otitis–sinusitis was less frequently reported (2006–2020, 45%; 2020–2021, 22%; 2021–2023, 47%; P = 0.006). Other parameters, i.e. age, sex, symptom duration or initial C-reactive protein level, remained unaffected. Compared to baseline, lumbar punctures were more frequently delayed (on admission day, 2006–2020, 89%; 2020–2021, 74%; 2021–2022, 86%; P = 0.002) and outcomes were worse (‘good recovery’, 2020–2021, OR 0.5, 95% CI 0.3–0.8). Conclusion During the COVID-19 pandemic, we observed worse outcomes in patients with pneumococcal meningitis. This may be explained by differing adherence to restrictions according to risk groups or by reduced health care quality.