Dramatic reduction of mortality in pneumococcal meningitis

• Published in: Critical care (London, England) Vol. 20; no. 1; p. 312
• Main Authors: Buchholz, Grete, Koedel, Uwe, Pfister, Hans-Walter, Kastenbauer, Stefan, Klein, Matthias
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-10-2016; BioMed Central
• Subjects: Adult; Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Bacterial meningitis; Ceftriaxone - pharmacology; Ceftriaxone - therapeutic use; Complications and side effects; Dexamethasone - pharmacology; Dexamethasone - therapeutic use; Female; Germany - epidemiology; Humans; Male; Meningitis, Pneumococcal - epidemiology; Meningitis, Pneumococcal - mortality; Middle Aged; Mortality; Physiological aspects; Retrospective Studies; Risk factors; Steroids - pharmacology; Steroids - therapeutic use; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - pathogenicity; United Kingdom; United Kingdom; Bacterial meningitis; CNS infection; Neurocritical care; Intracranial complications; Pneumococcal meningitis; Streptococcus pneumoniae
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/s13054-016-1498-8

Acute bacterial meningitis is still a life threatening disease.
We performed a retrospective observational study on the clinical characteristics of consecutively admitted patients with acute pneumococcal meningitis in a single tertiary care center in central Europe (from 2003 until 2015). Data were compared with a previously published historical group of 87 patients treated for pneumococcal meningitis at the same hospital (from 1984 until 2002).
Fifty-five consecutive patients with microbiologically proven pneumococcal meningitis were included. Most striking, mortality was down to 5.5 %, which was significantly lower than in the historical group where 24.1 % of the patients did not survive. Intracranial complications during the course of the disease were common and affected half of the patients. Unlike in the historic group, most of the intracranial complications (except ischemic stroke) were no longer associated with a low Glasgow Outcome Score at discharge.
The drastic reduction of mortality proves there have been important advances in the treatment of pneumococcal meningitis. Nevertheless, the fact that only 44.2 % of survivors had a full recovery indicates that the search for new adjunctive treatment options must be ongoing.