Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit:: clinical manifestations, management and prognostic factors

Objective. To study the clinical features, management and prognostic factors associated with adverse clinical outcome in a series of patients with acute community-acquired bacterial meningitis admitted to the intensive care unit (ICU). Design and setting. Descriptive, prospective study at two ICUs of a university hospital over a 6-year period. Patients. Sixty-four episodes in 62 adults with acute community-acquired bacterial meningitis admitted to the ICU. Results. Most of the patients (95.3%) were admitted to the ICU presenting with altered mental status (the median value of Glasgow Coma Scale (GCS) was 11). Overall mortality rate was 10.9% (7 patients) and 11 (17.1%) developed adverse clinical outcome (death or severe neurologic deficit). The features associated with adverse clinical outcome were: age over 50 years, seizures or focal neurologic signs at admission, a GCS score of 10 or less and an APACHE II score more than 13 at admission to the ICU. Only the severity of the disease determined according to the APACHE II scale was independently associated with adverse clinical outcome after a multivariate analysis was performed (adjusted odds ratio =8.74; 95% CI =1.70-44.77; p=0.009). All patients were empirically treated with third-generation cephalosporins and dexamethasone was used in 40 cases (62.5%). Ten patients (15.6%) received mannitol, nine of them after a transcranial Doppler sonography recording had been performed. Conclusions. In adult patients with acute community-acquired bacterial meningitis admitted to the ICU, the overall severity of the disease within 24 h of admission may be the major indicator of adverse in-hospital clinical outcome.