Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis
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RESEARCH ARTICLE
Open Access
Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania E. Matulyte1* , S. Kiveryte2, R. Paulauskiene1, E. Liukpetryte1, R. Vaikutyte1 and R. Matulionyte1
Abstract Background: The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM. Methods: Our retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis. Results: The median patient age was 36 (IQR 24–56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0–90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count 2.2 g/l) CSF protein level, a low (< 1.9 mmol/l) CSF glucose level, and a CSF glucose/blood glucose ratio < 0.23 — with a compatible clinical picture [8]. Bacterial meningitis was considered community-acquired if the patients had not been previously hospitalized or the onset of the disease had occurred 2 weeks after discharge from the hospital or 4 weeks after surgical treatment. Time to antibiotic therapy was calculated as time from arrival at hospital to administration of the first dose of antibiotic therapy. Two or more cases of the same serogroup in primary educational child care institutions, schools, living quarters or parallel services in a period of 4 weeks; three or more
Matulyte et al. BMC Infectious Diseases
(2020) 20:733
cases of the same serogroup over a period of 3 months in a determinated part of the population in a given territory or incidence ≥10/100,000 inhabitan
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