Clinical features and prognosis factors of community-acquired acute bacterial meningitis in Spain
Abstract number: P713
Sulleiro E., Rodriguez D., Almirante B., Amaya-Villar R., Fernández-Viladrich P., Rodrigo C., Fontanals D., Catalan P., Meseguer M.A., Colomina J., Prats G.
Objective: We conducted a multicentre study to determine clinical features and prognostic factors of community-acquired acute bacterial meningitis (ca-ABM) in nine hospitals of the Spanish Network for Investigation in Infectious Pathology (REIPI)
Methods: From Nov 2003 to Sept 2006 all patients >29 days diagnosed of ca-ABM were prospectively evaluated. The diagnosis was based on clinical condition, chemical and microbiological results in cerebrospinal fluid (CSF) and/or blood. Outcomes were classified as favourable or unfavourable (death or cure with disabilities). Predictors were identified through logistic-regression analysis.
Results: Four hundred and fifty five patients were included, 56% were men, the median age was 42 years (range: <191), Streptococcus pneumoniae (Sp) 43% were the most common aetiology agent followed to Neisseria meningitidis (Nm) 30%, Listeria monocytogenes (Lm) 13% and others 14%. Nm was the most common pathogen among patients 18 years (45.9%) and Sp in >18 years (80.7%). Predisposing conditions were oto-mastoiditis or sinusitis in 20% of the cases, previous immunosuppression (16.7%), diabetes (12.4%), CSF leak (8.5%) and alcoholism or cirrhosis (8.5%). The triad of fever, neck stiffness and altered mental status was present in 43.7% of the episodes. Rash was present in 20% of the cases, 12% had focal neurological deficits and 9% seizures. Penicillin susceptibility was tested in 146 Sp strains; of which 21.2% showed intermediate resistance (IR) and 4.8% resistance (R); of 119 Nm strains 6.7% presented IR to cefotaxim. Ampicillin susceptibility was tested in 39 Lm strains and all were sensible. Outcome was unfavourable in 26% of the cases with an overall mortality of 14%. In the multivariate model the unfavourable outcome risk factors appeared: age 65 years, respiratory failure, neurological deficits and seizures during treatment.
Conclusions: The most common pathogens causing ca-ABM in our area are Sp, Nm and Lm. Unfavourable outcome is high, so particular attention should be done to people with identified risk factors.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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