Community-acquired bacterial meningitis in adults: in-hospital prognosis, long term disability and determinants of outcome in a multicentre prospective cohort.,Clinical Microbiology and Infection

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Community-acquired bacterial meningitis in adults: in-hospital prognosis, long term disability and determinants of outcome in a multicentre prospective cohort.
Clinical Microbiology and Infection ( IF 10.9 ) Pub Date : 2020-01-10 , DOI: 10.1016/j.cmi.2019.12.020
S Tubiana ₁ , E Varon ₂ , C Biron ₃ , M-C Ploy ₄ , B Mourvillier ₅ , M-K Taha ₆ , M Revest ₇ , C Poyart ₈ , G Martin-Blondel ₉ , M Lecuit ₁₀ , E Cua ₁₁ , B Pasquet ₁₂ , M Preau ₁₃ , B Hoen ₁₄ , X Duval ₁₅ ,

Affiliation

Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France.
National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France.
CHU Limoges, Observatoires Régionaux Du Pneumocoque, Limoges, France.
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris University, Paris, France.
Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France.
Infectious Diseases and Intensive Care Unit, INSERM U 1230, CHU Rennes, Rennes University, Rennes, France.
Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Centre for Streptococci, APHP, France.
CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France; INSERM, UMR1043, Toulouse, France.
Institut Pasteur, Biology of Infection Unit, INSERM U1117, National Reference Centre and WHO Collaborating Center for Listeria, Paris, France; Université de Paris, Hôpital Universitaire Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Institut Imagine, APHP, Paris, France.
Infectious Diseases Department, CHU Nice, France.
Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Unité de Recherche Clinique Paris Nord, Paris, France.
GRePS, Lyon 2 University, Lyon, France.
CHU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Vandœuvre-lès-Nancy, France.
Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.

Objectives

To identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM).

Methods

In a prospective multicentre cohort study (COMBAT; February 2013 to July 2015), all consecutive cases of CABM in the 69 participating centres in France were enrolled and followed up for 12 months. Factors associated with unfavourable outcome were identified by logistic regression and long-term disability was analysed.

Results

Among the 533 individuals enrolled, (Streptococcus pneumoniae 53.8% (280/520 isolates identified), Neisseria meningitidis 21.3% (111/520), others 24.9% (129/520)), case fatality rate was 16.9% (90/533) and unfavourable outcome occurred in 45.0% (225/500). Factors independently associated with unfavourable outcome were: age >70 years (adjusted odds ratio (aOR) 4.64; 95% CI 1.93–11.15), male gender (aOR 2.11; 95% CI 1.25–3.57), chronic renal failure (aOR 6.65; 95% CI 1.57–28.12), purpura fulminans (aOR 4.37; 95% CI 1.38–13.81), localized neurological signs (aOR 3.72; 95% CI 2.29–6.05), disseminated intravascular coagulation (aOR 3.19; 95% CI 1.16–8.79), cerebrospinal fluid (CSF) white-cell count <1500 cells/μL (aOR 2.40; 95% CI 1.42–4.03), CSF glucose concentration (0.1–2.5 g/L: aOR 1.92; 95% CI 1.01–3.67; <0.1 g/L: aOR 2.24; 95% CI 1.01–4.97), elevated CSF protein concentration (aOR 1.09; 95% CI 1.03–1.17), time interval between hospitalization and lumbar puncture >1 day (aOR 2.94; 95% CI 1.32–6.54), and S. pneumoniae meningitis (aOR 4.99; 95% CI 1.98–12.56), or meningitis other than N. meningitidis (aOR 4.54; 95% CI 1.68–12.27). At 12 months, 26.7% (74/277) had hearing loss, 32.8% (87/265) depressive symptoms, 31.0% (86/277) persistent headache, and 53.4% had a physical health-related quality of life (142/266) <25th centile of the distribution of the score in the general French population (p < 0.0001).

Conclusions

The burden of CABM (death, disability, depression, impaired quality of life and hearing loss) is high. Identification of cases from the first symptoms may improve prognosis.

ClinicalTrial

Gov identification number: NCT01730690.

中文翻译：

成人社区获得性细菌性脑膜炎：多中心前瞻性队列中的住院预后、长期残疾和结果决定因素。

目标

确定与社区获得性细菌性脑膜炎 (CABM) 成人住院结局不良（死亡或残疾）相关的因素。

方法

在一项前瞻性多中心队列研究（COMBAT；2013 年 2 月至 2015 年 7 月）中，法国 69 个参与中心的所有连续 CABM 病例均被纳入并随访 12 个月。通过逻辑回归确定与不利结果相关的因素，并分析长期残疾。

结果

在入组的533人中，（肺炎链球菌53.8%（280/520分离株），脑膜炎奈瑟菌21.3%（111/520），其他24.9%（129/520）），病死率为16.9%（90/533） 45.0% (225/500) 发生不良结局。与不良结果独立相关的因素是：年龄 > 70 岁（调整优势比 (aOR) 4.64；95% CI 1.93–11.15），男性（aOR 2.11；95% CI 1.25–3.57），慢性肾功能衰竭（aOR 6.65； 95% CI 1.57–28.12)，暴发性紫癜（aOR 4.37；95% CI 1.38–13.81），局部神经系统体征（aOR 3.72；95% CI 2.29–6.05），弥散性血管内凝血（aOR 3.19；95% CI 1.16–8.79），脑脊液（CSF）白细胞计数 <1500 个细胞/μL（aOR 2.40；95% CI 1.42–4.03），CSF 葡萄糖浓度（0.1–2.5 g/L：aOR 1.92；95% CI 1.01–3.67；<0.1 g/L：aOR 2.24；95% CI 1.01–4.97）、CSF 蛋白浓度升高（aOR 1.09；95% CI 1.03–1.17）、住院和腰椎穿刺之间的时间间隔 > 1 天（aOR 2.94；95% CI 1.32–6.54）和肺炎链球菌脑膜炎（ aOR 4.99；95% CI 1.98–12.56)，或脑膜炎奈瑟菌以外的脑膜炎（aOR 4.54；95% CI 1.68–12.27）。12 个月时，26.7% (74/277) 有听力损失，32.8% (87/265) 有抑郁症状，31.0% (86/277) 持续性头痛，53.4% 有与身体健康相关的生活质量 (142/ 266) <25th 百分位的分数在法国普通人群中的分布 (p < 0.0001)。