Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit
Authors' conclusion
Mortality rate in critically ill patients with pneumococcal meningitis is lower than previously reported. Delay in antibiotic treatment following admission is the only amendable factor associated with mortality.
Study context
- Population
- ICU patients with severe community-acquired Streptococcus pneumoniae meningitis, 16 Spanish intensive care units (ICUs)
- Participants
- 255 patients · 16 ICUs
- Outcome
- Clinical response after antibiotic treatment initiation
- Follow-up
- 72 h
Methodological detailsobservational, multicentre
- Observational
- Multicentre
Main finding
As reported in the abstract
Clinical response
Clinical response achieved
65.8%
Early treatment failure associated with invasive mechanical ventilation
10.74
multivariate, OR 10.74; 95% CI 3.04–37.95p < 0.001
Early treatment failure associated with septic shock
1.18
multivariate, OR 1.18; 95% CI 1.03–1.36p = 0.017
Observational data: associations, not effects.
Further findings
30-day mortality
- 30-day mortality rate
- 13.7%
- Independently associated: delay in start of antibiotic treatment
- 18.69 (OR 18.69; 95% CI 2.13-163.97, p = 0.008)
- Independently associated: SOFA score
- 1.36 (OR 1.36; 95% CI 1.12-1.66, p = 0.002)
- Independently associated: early treatment failure (OR 21.75 (3.40-139.18), p = 0.001)
Microbiology and treatment
- Cerebrospinal fluid (CSF) culture positive
- 89.7%
- Non-susceptible to penicillin
- 25.7%
- Non-susceptible to ceftriaxone or cefotaxime
- 5.2%
- Empiric third-generation cephalosporin
- 47.5%
- Plus vancomycin
- 27.8%
- Plus linezolid
- 12.9%
- Steroid treatment
- 88.6%
Safety
- Neurological complications, n (%)
- 124 (48.63%)
Original publication
Severe community-acquired Streptococcus pneumoniae bacterial meningitis: clinical and prognostic picture from the intensive care unit. Crit Care. Published 23 February 2023. doi:10.
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