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

Jérôme Dimet,Isabelle Patry,Nicolas Van Grunderbeeck,Sandra Bourdon,Adriatsiferana Ramanantsoa,Isabelle Gorenne,Fanny Vuotto,Jean-Luc Desmaretz,Pierrick Cronier,Josette Raymond,Véronique Vernet-Garnier,Nicolas Degand,Stéphanie Robaday-Voisin,Christophe Burucoa,Sarah Tubiana,Paul Le Turnier,Aurore Bousquet,Charles Cazanave,Pierrejean Pierrejean,Florence Rousseau,Matthieu Marx,Patrice Plessis,Christine Segonds,Marie-Cécile Ploy,Catherine Chirouze,Cédric Joseph,Bernard Page,Sandrine Henard,Vincent Le Moing,Amélie Chabrol,Estelle Marcault,Jérôme Guinard,Nadia Valin,Marc Lecuit,Nicolas Fortineau,Silvija Males,Diane Descamps,Thomas Guimard,Tahar Hadou,Magali Garcia,Blandine Pasquet,Guilène Barnaud,Guillaume Mellon,Natacha Mrozek,Emmanuelle Varon,Denis Garot,Aurore Mbadi,Claire Poyart,Gabriela Illes,Claire Plassart,Carlo Saroufim,Aurélien Dinh,Jacques Tankovic,Marie-Emmanuelle Juvin,Patrice Boubeau,Charlotte Biron,Chantal Lemble,Marie Poupard,Mathieu Cabon,Florence Suy,Stéphane Gaudry,Anne-Laure Roux,Yohan Nguyen,Olivia Son,Simon Sunder,Stéphanie Balavoine,Sophie Boyer,François Bricaire,Alexis Bozorg-Grayeli,Christophe Canevet,Frédéric Robin,Céline Legrix,François Caron,Dominique Salmon,Laurent Argaud,Typhaine Billard Pomares,Marine Grosset,Nadia Anguel,Anne-Cécile Hochart,Renaud Verdon,Maja Ogielska,Philippe Lanotte,Vanessa Chanteperdrix-Marillier,Philippe Cormier,Lionel Piroth,Olivier Matray,Bruno Frachet,Michel Brun,Sylvie Ledru,François Raffi,Laurent Raskine,Edith Malpote,Régine Baraduc,David Morquin,Louis Bernard,Bernard Clair,Anne Dao-Dubremetz,Anne Carricajo,Claude Fabe,Xavier Duval,Adrien Lemaignen,Claire Lhommet,Stéphane Bland,Emmanuelle Cambau,Samer Kayal,Olivier Lesens,Daniel Levy Bruhl,Nathalie Fonsale,Marion Levast,Nathalie Soismier,Bruno Mourvillier,Hugues Cordel,Stéphane Mouly,Caroline Charlier-Woerther,Matthieu Revest,Carine Roy,Garandeau Garandeau,François Goehringer,Virginie Vitrat,Julien Colot,Valérie Gregoire-Faucher,Joy Mootien Yoganaden,Valérie Sivadon-Tardy,Laurent Bret,Dominique Bertei,Georges Bernars,Jean-Pierre Helene,Luc Quaesaet,Alain Gravet,Jean Cabalion,Olivier Gaillot,H Chaussade ,C Flateau ,Hervé Lécuyer ,Cédric Laouénan ,F Faibis ,G Camuset ,B Henry ,E Forestier ,A Riché ,S Arista ,H Laurichesse ,Jean-Pierre Romaszko ,Manuela Sébire ,C Chaplain ,P Poubeau ,C Rapp ,Cécile Royer ,Elsa Brocas ,J Boileau ,Éric Caumes ,Pierre‐François Dequin ,R Masson ,Élodie Descloux ,F Méchaï ,C Gubavu ,S Jaffuel ,D Delaune ,T Challan-Belval ,Bruno Hoën ,A Michon ,Cécile Brun ,S Dargère ,L Escaut ,D Vittecoq ,Didier Tandé ,Pierre‐Édouard Bollaert ,J Cousson ,F Vandenesch ,Solen Kernéis ,Cédric Bretonnière ,L Portel ,M.c Meyohas ,S Dekeyser ,Sophie Nguyen ,Irène Jarrin ,Stéphane Bonacorsi ,Jean‐Luc Diehl ,E Dénes ,Françoise Jauréguy ,S Picot ,M Vergnaud ,Marie Préau ,Emilie Bessède ,Laurence Armand-Lefèvre ,A Péchinot ,F Lacassin ,Bernard Castan ,J Buret ,Amandine Gagneux‐Brunon ,Solène Patrat-Delon ,T De Broucker ,Jean‐Marie Conil ,Guillaume Martin‐Blondel ,Jean‐Luc Schmit ,D Guélon ,Éric Cua ,Muhamed‐Kheir Taha ,E Laurens ,Statistical Analyses ,M Saada ,I Gueït ,Thiérry Prazuck ,I Lamaury ,Guillaume Béraud ,Ludovic Lemée ,E Oziol ,Audrey Mérens ,M Vidal

doi:10.1016/j.cmi.2019.12.020

Abstract

ObjectivesTo identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM). MethodsIn 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. ResultsAmong 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). ConclusionsThe 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. ClinicalTrialGov identification number: NCT01730690.

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