Adult bacterial meningitis—a quality registry study: earlier treatment and favourable outcome if initial management by infectious diseases physicians

Bacterial meningitis is one of the harmful and deadly infectious diseases, and any delay in its treatment will lead to death. In this paper, a prognostic model was developed to predict the risk of death amongst probable cases of bacterial meningitis. Our prognostic model was developed using a decision tree algorithm on the national meningitis registry of the Iranian Center for Disease and Prevention (ICDCP) containing 3,923 records of meningitis suspected cases in 2018–2019. The most important features have been selected for the model construction. This model can predict the mortality risk for the meningitis probable cases with 78% accuracy, 84% sensitivity, and 73% specificity. The identified variables in prognosis the death included age and CSF protein level. CSF protein level (mg/dl) <= 65 versus > 65 provided the first branch of our decision tree. The highest mortality risk (85.8%) was seen in the patients >65 CSF protein level with 30 years < of age. For the patients <=30 year of age with CSF protein level >137 (mg/dl), the mortality risk was 60%. The prognostic factors identified in the present study draw the attention of clinicians to provide early specific measures, such as the admission of patients with a higher risk of death to intensive care units (ICU). It could also provide a helpful risk score tool in decision-making in the early phases of admission in pandemics, decrease mortality rate and improve public health operations efficiently in infectious diseases.

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1395. Comparison of Four Recommendations Guiding the Use of Neuroimaging in the Management of Bacterial Meningitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1259 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S507-S507

Author(s):

Nicola Park ◽

Rodrigo Hasbun

Keyword(s):

Bacterial Meningitis ◽

Infectious Diseases ◽

Ct Scan ◽

Clinical Management ◽

Tertiary Care ◽

External Ventricular Drainage ◽

Direct Result ◽

Head Ct ◽

Brain Ct ◽

Ct Findings

Abstract Background Currently multiple sets of recommendations exist to guide the use of cranial imaging before lumbar puncture in adults with suspected meningitis. We aimed to compare the utility of the four main guidelines [Infectious Diseases Society of America (IDSA), European Society for Clinical Microbiology and Infectious Diseases (ESCMID), UK, and Swedish guidelines] in detecting major head CT scan findings that eventually impacted clinical management in adults with community-acquired bacterial meningitis. Methods A retrospective observational study of 111 adults (age > 17 years) with community-acquired bacterial meningitis admitted to 10 tertiary care hospitals in Houston TX, between December 2004 and March 2016. Major and minor CT findings were stratified based on their inclusion status within the four separate guidelines. Results A total of 38 (34%) patients had minor head CT scans (small ischemic white matter changes, lacunar strokes) and 17 (15%) patients had major CT findings (hydrocephalus, subarachnoid hemorrhage or interventricular hemorrhage, cerebral edema, pneumocephalus, ventriculomegaly, septic embolus, hindbrain herniation, and temporal lobe encephalitis). Of those 17 with major CT findings, 6 patients had a change in clinical management [External Ventricular Drainage (EVD) placement] as a direct result of their CT findings. The IDSA set of guidelines was the only one that included all of the major CT scan findings and all the cases in which the findings of a brain CT resulted in a change in management (EVD placement). Conclusion The IDSA was the most inclusive guideline in regards to (1) indications for cranial imaging that would have detected all major abnormal brain CT findings and 2) including cranial imaging that resulted in significant changes in clinical management in adults with community-acquired bacterial meningitis. Disclosures All authors: No reported disclosures.

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ERRATUM

PEDIATRICS ◽

10.1542/peds.82.6.869a ◽

1988 ◽

Vol 82 (6) ◽

pp. 869-869

Keyword(s):

Bacterial Meningitis ◽

Infectious Diseases ◽

American Academy ◽

American Academy Of Pediatrics

In the American Academy of Pediatrics' statement, "Treatment of Bacterial Meningitis" by the Committee on Infectious Diseases (Pediatrics 1988;81:904-907), there is an error on p 906 in the last sentence under the heading, "Subsequent Therapy." The words, "Cefotaxime, or" should be deleted and the sentence should read: "Ceftazidime for Pseudomonas meningitis should be satisfactory when used singly or in combination with an aminoglycoside."

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Meropenem versus Cefotaxime and Ampicillin as Empirical Antibiotic Treatment in Adult Bacterial Meningitis: a Quality Registry Study, 2008 to 2016

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00883-19 ◽

2019 ◽

Vol 63 (11) ◽

Cited By ~ 1

Author(s):

Magnus Brink ◽

Martin Glimåker ◽

Jan Sjölin ◽

Pontus Naucler

Keyword(s):

Propensity Score ◽

Bacterial Meningitis ◽

Propensity Score Matching ◽

Primary Outcome ◽

Empirical Treatment ◽

Acute Bacterial Meningitis ◽

Quality Registry ◽

Treatment Regimens ◽

Quality Register ◽

Third Generation Cephalosporins

ABSTRACT Cefotaxime, alone or with ampicillin, is frequently used in empirical treatment of acute bacterial meningitis (ABM). Meropenem is a less extensively investigated alternative. The aim of the study was to investigate the effects of empirical treatment with meropenem compared to cefotaxime plus ampicillin on outcome in ABM. The study was based on data from the Swedish quality register for ABM collected between January 2008 and December 2016. Propensity score matching was performed to adjust for baseline differences between the groups. Mortality within 30 days was the primary outcome. The treatment regimens of interest were administered to 623 patients; 328 were given cefotaxime plus ampicillin whereas 295 received meropenem. Using propensity score matching, the 30-day mortality rates were 3.2% in the cefotaxime plus ampicillin group and 3.6% in the meropenem group. For matched cases, the odds ratio (OR) for 30-day mortality for meropenem versus cefotaxime plus ampicillin was 1.15 (confidence interval [CI], 0.41 to 3.22; P = 0.79). The OR for 90-day mortality was 1.47 (CI, 0.62 to 3.52; P = 0.38) and for unfavorable outcome was 1.10 (CI, 0.75 to 1.63; P = 0.62). The findings of our study indicate that meropenem is an effective empirical treatment option for adults with community-acquired ABM. However, to spare carbapenems, guidelines should continue to recommend third-generation cephalosporins as an empirical treatment for the majority of patients with ABM.

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