Background
Methods
Study population
Diagnosis of acute bacterial meningitis
Microbiologic methods
Definitions
Statistical analysis
Results
Population studied
Group I (non-elderly) | Group II (elderly) | RR (95% CI) | P value | |
---|---|---|---|---|
N = 427 | N = 208 | |||
Age (yrs) | 32.0 (22.0–54.0) | 74.0 (68.0–78.0) | ---- | < 0.0001 |
15–24 yrs (%) | 134 (31.4) | ---- | ---- | ---- |
25–34 yrs (%) | 59 (13.8) | ---- | ---- | ---- |
35–44 yrs. (%) | 60 (14.0) | ---- | ---- | ---- |
45–54 yrs (%) | 77 (18.0) | ---- | ---- | ---- |
55–64 yrs (%) | 97 (22.7) | ---- | ---- | ---- |
≥ 65 yrs (%) | ---- | 208 (100) | ---- | ---- |
Male (%) | 205 (48.0) | 99 (47.6) | 0.99 (0.79–1.24) | 0.9895 |
Co-morbidity (%) | 168 (39.3) | 148 (71.1) | 2.49 (1.93–3.22) | < 0.0001 |
Cancer† (%) | 46 (10.8) | 40 (19.2) | 1.52 (1.17–1.97) | 0.0051 |
Alcohol abuse (%) | 43 (10.1) | 21 (7.1) | 1.00 (0.69–1.45) | 0.8963 |
Liver cirrhosis (%) | 15 (3.5) | 8 (3.8) | 1.06 (0.60–1.88) | 0.9878 |
Diabetes mellitus (%) | 35 (8.2) | 46 (22.1) | 1.94 (1.54–2.44) | < 0.0001 |
Chronic lung disease‡ (%) | 11 (2.6) | 25 (12.0) | 2.27 (1.27–2.91) | < 0.0001 |
Chronic cardiovascular disease§ (%) | 15 (3.5) | 59 (28.6) | 3.00 (2.51–3.59) | < 0.0001 |
Chronic renal failure (%) | 17 (4.0) | 21 (10.1) | 1.76 (1.29–2.40) | 0.0041 |
Chronic debilitating diseases¶ (%) | 8 (1.9) | 17 (8.2) | 2.17 (1.62–2.91) | 0.0003 |
Immunosuppressionll (%) | 60 (14.0) | 42 (20.2) | 1.36 (1.04–1.77) | 0.0428 |
Charlson Index ≥ 1 | 134 (31.4) | 136 (65.4) | 2.55 (2.00–3.24) | < 0.0001 |
0 (%) | 283 (68.6) | 72 (34.6) | 0.42 (0.33–0.53) | < 0.0001 |
1–2 (%) | 87 (20.4) | 80 (38.5) | 1.75 (1.41–2.17) | < 0.0001 |
3–4 (%) | 22 (5.1) | 42 (20.2) | 2.26 (1.81–2.81) | < 0.0001 |
≥ 5 (%) | 25 (5.8) | 14 (5.7) | 1.10 (0.71–1.70) | 0.7984 |
Nosocomial acquisition (%) | 14 (3.3) | 11 (5.3) | 1.36 (0.86–2.15) | 0.3149 |
Recurrent meningitis (%) | 18 (4.2) | 10 (4.8) | 1.09 (0.66–1.82) | 0.8924 |
Clinical features
Group I (non-elderly) | Group II (elderly) | RR (95% CI) | P value | |
---|---|---|---|---|
N = 427 | N = 208 | |||
Interval symptoms-admission (hrs) | 24.0 (24.0–37.0) | 27.5 (24.0–37.0) | ---- | 0.3822 |
Prior antimicrobial therapy (%) | 126 (29.5) | 77 (37.0) | 1.25 (1.00–1.57) | 0.0696 |
Extrameningeal infection† (%) | 96 (22.5) | 79 (37.9) | 1.61(1.29–2.00) | < 0.0001 |
Pneumonia (%) | 17 (4.0) | 20 (9.6) | 1.72 (1.25–2.37) | 0.0077 |
ENT infection (%) | 56 (8.8) | 33 (5.2) | 1.16 (0.86–1.56) | 0.4149 |
Urinary tract infection (%) | 9 (1.4) | 18 (2.8) | 2.13 (1.59–2.86) | 0.0003 |
Fever (%) | 412 (96.5) | 193 (92.8) | 0.64 (0.44–0.93) | 0.0625 |
Level of consciousness (%) | ||||
Normal (%) | 174 (40.7) | 49 (23.6) | 0.57 (0.43–0.75) | < 0.0001 |
Abnormal (%) | 229 (62.6) | 142 (68.3) | 1.53 (1.20–1.93) | 0.0006 |
Coma (%) | 24 (5.6) | 17 (8.2) | 1.39 (0.95–2.04) | 0.1639 |
Neck stiffness (%) | 357 (83.6) | 129 (62.0) | 0.50 (0.41–0.62) | < 0.0001 |
Meningeal triad present (%) | 208 (48.7) | 104 (50.0) | 1.04 (0.83–1.29) | 0.8275 |
Skin rash (%) | 153 (35.8) | 19 (9.1) | 0.27 (0.17–0.62) | < 0.0001 |
Interval admission-therapy (hrs) | 3.0 (1.0–6.0) | 4.0 (2.0–12.0) | ---- | < 0.0001 |
Focal neurologic signs on admission (%) | 63 (14.7) | 43 (20.7) | 1.30 (1.00–1.69) | 0.0777 |
Seizures on admission (%) | 33 (7.7) | 13 (6.2) | 0.85 (0.53–1.37) | 0.6091 |
Cerebral computed tomography (%) | 163 (57.8) | 113 (75.8) | 1.55 (1.24–1.93) | 0.0002 |
CSF findings, microbiologic features and etiology
Group I (non-elderly) | Group II (elderly) | RR (95% CI) | P value | |
---|---|---|---|---|
N = 427 | N = 208 | |||
CSF findings
| ||||
Protein content, g/l | 3.2 (1.5–6.5) | 3.8 (1.8–7.3) | ---- | 0.0306 |
mg/dl | 320 (150–650) | 380 (180–730) | ||
CSF/plasma glucose ratio | 0.24 (0.07–0.45) | 0.22 (0.08–0.42) | ---- | 0.7681 |
Cells/mm3
| 1022 (301–2993) | 1026 (290–2968) | ---- | 0.7490 |
Predominance PML †
| 385 (94.4) | 183 (91.5) | 0.76 (0.52–1.11) | 0.2446 |
Positive CSF Gram stained smear (%) | 199 (46.6) | 68 (32.7) | 0.67 (0.52–0.85) | 0.0012 |
Positive CSF culture (%) | 309 (72.4) | 141 (67.8) | 0.87 (0.68–1.09) | 0.2721 |
Positive blood culture (%)‡
| 184 (43.4) | 104 (51.5) | 1.25 (1.00–1.58) | 0.0616 |
Etiology
§
| ||||
Meningococcal (%) | 179 (41.9) | 24 (11.5) | 0.28 (0.19–0.41) | < 0.0001 |
Pneumococcal (%) | 91 (21.3) | 59 (28.4) | 1.28 (1.01–1.63) | 0.0622 |
Listerial & grampositive bacilli (%) | 33 (7.7) | 29 (13.9) | 1.93 (1.12–2.01) | 0.0196 |
Other Gram-positive cocci (%) | 22 (5.1) | 13 (6.2) | 1.14 (0.73–1.79) | 0.7012 |
Gram-negative bacilli (%) | 18 (4.2) | 21 (10.1) | 1.72 (1.25–2.35) | 0.0065 |
Haemophilus influenzae (%) | 9 (2.1) | 5 (2.4) | 1.09 (0.54–2.23) | 0.9685 |
Mixed (%) | 2 (0.5) | 2 (1) | 1.53 (0.57–4.11) | 0.8393 |
Other | 2 (0.5) | 1 (0.5) | 1.02 (0.20–5.06) | 0.5517 |
Unknown origin (%) | 71 (16.5) | 54 (25.9) | 1.43 (1.12–1.82) | 0.0076 |
Evolving features and outcome
Group I (non-elderly) | Group II (elderly) | RR (95% CI) | P value | |
---|---|---|---|---|
N = 427 | N = 208 | |||
Neurologic complications (%)
|
80 (18.7)
|
64 (30.8)
|
1.52 (1.21–1.90)
|
0.0009
|
New focal neurologic signs (%) | 23 (5.4) | 16 (7.7) | 1.27 (0.86–1.89) | 0.3372 |
Coma (%) | 57 (13.3) | 48 (23.1) | 1.51 (1.18–1.94) | 0.0028 |
Seizures (%) | 46 (10.7) | 33 (15.9) | 1.33 (1.00–1.77) | 0.0897 |
New cranial palsies (%) | 17 (4.0) | 17 (8.2) | 1.57 (1.10–2.25) | 0.0439 |
Extra-neurologic complications (%)
|
109 (25.5)
|
94 (45.2)
|
1.75 (1.41–2.18)
|
< 0.0001
|
Septic shock (%) | 65 (15.2) | 35 (16.8) | 1.08 (0.80–1.44) | 0.7125 |
Acute respiratory failure (%) | 60 (14.0) | 46 (22.1) | 1.42 (1.10–1.82) | 0.0145 |
Acute renal failure (%) | 40 (9.4) | 48 (23.1) | 1.86 (1.48–2.35) | < 0.0001 |
Consumption coagulopathy (%) | 39 (9.1) | 15 (7.2) | 0.84 (0.54–1.31) | 0.5071 |
Therapeutics
| ||||
Adequate empiric antibiotic therapy (%) | 398 (93.2) | 187 (89.9) | 0.76 (0.54–1.08) | 0.1956 |
Dexamethasone therapy (%) | 142 (33.2) | 83 (39.9) | 1.21 (0.97–1.52) | 0.1198 |
Vasoactive drugs (%) | 69 (16.1) | 38 (18.3) | 1.10 (0.83–1.46) | 0.5797 |
Mechanical ventilation (%) | 67 (15.7) | 39 (18.7) | 1.15 (0.87–1.52) | 0.3915 |
Dialysis (%) | 9 (2.1) | 8 (3.8) | 1.45 (0.87–2.44) | 0.3116 |
Outcome
| ||||
Overall mortality rate (%) | 50 (11.7) | 62 (29.8) | 1.98 (1.60–2.46) | < 0.0001 |
Meningococcal (%) | 8 (4.5) | 3 (12.5) | 2.49 (0.88–7.10) | 0.2494 |
Pneumococcal (%) | 14 (15.0) | 19 (31.7) | 1.68 (1.14–2.48) | 0.0259 |
Listerial & grampositive bacilli (%) | 7 (21.2) | 9 (31.0) | 1.29 (0.75–2.23) | 0.5544 |
Other grampositive cocci (%) | 9 (40.9) | 6 (46.1) | 1.14 (0.48–2.70) | 0.9597 |
Gramnegative bacilli (%) | 10 (55.5) | 12 (57.1) | 1.03 (0.57–1.86) | 0.8225 |
Haemophilus influenzae (%) | 1 (11.1) | 0 (0.0) | 1.50 (0.30–7.43) | 0.7320 |
Mixed (%) | 0 (0.0) | 0 (0.0) | ---- | ---- |
Other | 0 (0) | 0 (0.0) | ---- | ---- |
Unknown etiology (%) | 1 (1.4) | 13 (24.1) | 2.51 (1.89–3.34) | 0.0002 |
Death attributable to meningitis (%) | 42 (9.8) | 43 (20.7) | 1.67 (1.30–2.13) | 0.0004 |
Post-meningitic sequelae† (%) | 42 (11.1) | 21 (14.4) | 1.22 (0.83–1.78) | 0.3945 |
Group I (non-elderly) | Group II (elderly) | RR (95% CI) | P value | |
---|---|---|---|---|
N = 427 | N = 208 | |||
Type of complication (%)
| ||||
None (%) | 3/292 (1.03) | 3/93 (3.2) | 3.07 (0.63–14.97) | 0.3263 |
Neurologic complications (%) | 9/26 (34.6) | 11/21 (52.4) | 1.34 (0.64–2.80) | 0.6124 |
Extra-neurologic complications (%) | 8/55 (14.5) | 11/51 (29.4) | 1.79 (0.82–3.93) | 0.2085 |
Both types (%) | 30/54 (55.5) | 33/43 (76.7) | 1.22 (0.83–1.79) | 0.4041 |
Extra-neurologic complications (%)
| ||||
New focal neurologic signs (%) | 13/23 (56.5) | 11/16 (68.7) | 1.13 (0.60–2.12) | 0.9105 |
Coma (%) | 37/57 (64.9) | 41/48 (85.4) | 1.17 (0.84–1.64) | 0.4429 |
Seizures (%) | 16/46 (34.8) | 21/33 (63.6) | 1.51 (0.88–2.58) | 0.1908 |
New cranial palsies (%) | 4/17 (23.5) | 11/17 (64.7) | 2.06 (0.76–5.58) | 0.2270 |
Extra-neurologic complications (%)
| ||||
Septic shock (%) | 30/65 (46.1) | 23/35 (74.3) | 1.35 (0.89–2.04) | 0.2178 |
Acute respiratory failure (%) | 22/60 (36.7) | 27/46 (58.7) | 1.38 (0.86–2.20) | 0.2360 |
Acute renal failure (%) | 19/40 (47.5) | 27/48 (56.2) | 1.12 (0.69–1.80) | 0.7823 |
Consumption coagulopathy (%) | 19/39 (48.7) | 11/15 (73.3) | 1.29 (0.72–2.31) | 0.5497 |