Risk factors for precocious mechanical ventilation in pneumococcal meningitis: a 12-year experience

Abstract number: P1359

Pagliano P., Attanasio V., Rossi M., Fraganza F., Esposito G., Conte M., Faella F.

Despite continuing improving in the field of intensive cares and infectious diseases therapy, pneumococcal meningitis still represents a life-threatening disease. Aim of our study was to evaluate the characteristics of patients with pneumococcal meningitis receiving precocious mechanical ventilation in respect to those with less severe disease presentation.

Materials and Methods: In a prospective study we enrolled adult patients with pneumococcal meningitis admitted in our department during a 12-year period. Epidemiological, clinical and laboratory findings at admission were investigated. Statistical analysis was performed by two-tailed c2 test, by Fisher exact test, and by Mann–Whitney U-test. Data are expressed as median and Interquartile range(IQR).

Results: One-hundred-eighty-four cases of pneumococcal meningitis were enrolled [median age 58 years (IQR 39–66), males 55%]. Eighty-five (46%) patients received mechanical ventilation within 48 hours from admission (Group A), among the remaining 99 patients (Group B) only 2 had to receive mechanical ventilation during the course of disease. Condition leading to immunodepression were present in 40 (47%) group A patients and 25 (25%) group B patients (p < 0.01; RR= 1.86; 95% CI 1.24–2.8). No significant difference was observed in respect to the incidence of cases with sinus or middle ear infection and in respect to the time between first symptoms evidence and admission to the hospital. Penicillin susceptible strains of Streptococcus pneumoniae were cultured in 28% of Group A patients and 17% of Group B patients. Laboratory findings are reported in the table. Mortality rate was 48% for group A and 2% for group B patients.

Discussion: Immunodepressed patients with pneumococcal meningitis are at high risk for precocious respiratory insufficiency. Factors commonly associated to higher meningitis mortality, such as low CSF glucose, high CSF protein and low WBC counts are present more frequently in cases with rapidly progressive disease needing precocious mechanical ventilation. These evidences suggest a close relationship between some delay in the setting of precocious immune response and patients presentation and outcome.

Table 1. Laboratory findings in respect to the necessity of mechanical ventilation*

 CSF cells (×103/mL)CSF glucose (mg/dl)CSF protein (mg/dl)WBC (×103/mL)Platelets (×103/mL)
Group A1.8 (0.6–7.8)7 (2–17)643 (360–950)17.4 (12–26)151 (121–239)
Group B3.5 (0.8–9)12 (5–31)498 (314–685)21.3 (16–28)229 (165–299)
* Data are expressed as median (IQR).

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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