Dexamethasone efficacy on bacterial meningitis – a retrospective analysis of Albanian adult patients

Arben Hazis Ndreu,Petrit Imer Bara,Elizana Ylber Petrela,Kastriot Mark Shytaj,Arjan Kareman Harxhi,Arben Sulejman Pilaca,Dhimiter Viktor Kraja,Ervin Çerçiz Mingomataj

doi:10.3855/jidc.51

Abstract

Research on the effects of corticosteroids in bacterial meningitis (BM) yielded conflicting results. While some studies reveal that corticosteroids improve the outcomes in BM treatments, others provide strong evidence that patients do not profit from this treatment. We investigated the factors that may impact the dexamethasone efficacy in patients with BM. In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre "Mother Theresa" of Tirana, Albania. They were all treated with dexamethasone. For study purposes, patients were divided into two subgroups: 1) Severely ill patients (Glasgow Coma Scale [GCS] <or= 7 and 2) Less severely ill patients (GCS 8-12). Patients were considered recovered when they reached a GCS >or= 13. Sixty-seven patients analyzed had a mean age of 43.8 +/- 17.0 years old, forty-five (67.2%) of whom were males. The mean recovery time (RT) was 3.5 +/- 1.3 days, and four (6%) died. In the severely ill subgroup (GCS <or= 7 points), the Pearson correlation between the dexamethasone daily dose and the RT was -0.579, p < 0.01 level (2-tailed). There was no correlation found in the less severely ill group of patients (GCS 8-12 points). This study suggests that the patients with lower GCS scores were significantly more likely to benefit from dexamethasone therapy. In this subgroup, high doses of corticosteroids can significantly reduce BM recovery time; however, patients with a high GCS do not benefit from dexamethasone therapy.

Highlights

Bacterial meningitis (BM) was first described in the early years of the twentieth century with a virtual mortality of 100%
probable acute bacterial meningitis (PABM) who were meningitis-symptomatic with a Glasgow Coma Scale (GCS) ≤ 13 whose cerebrospinal fluid (CSF) was macroscopically altered, with the total number of cells more than 400 cells/mm3 where the polymorphonuclears (PMN) represented at least 60% of them and a CSF to serum glucose concentration ratio of ≤ 50%
The main result emerging from this survey shows that benefits from dexamethasone therapy in PABM are evident, but they are more prominent in the severely ill patients

Summary

Introduction

Bacterial meningitis (BM) was first described in the early years of the twentieth century with a virtual mortality of 100%. Other studies revealed that corticosteroid therapy is most beneficial if it is started before the first dose of antibiotics [5,6,14,15], with results indicating that early treatment with dexamethasone improved the outcome and reduced the death risk in adults with. Methodology: In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre “Mother Theresa” of Tirana, Albania Conclusions: This study suggests that the patients with lower GCS scores were significantly more likely to benefit from dexamethasone therapy In this subgroup, high doses of corticosteroids can significantly reduce BM recovery time; patients with a high GCS do not benefit from dexamethasone therapy

Methods

Results

Conclusion