Severe community-acquired meningitis

Christophe Boisson,Renaud Vialet,Claude Martin,Sophie Arnaud

doi:10.1186/cc356

Christophe Boisson, Renaud Vialet + Show 2 more

Open Access

https://doi.org/10.1186/cc356

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Journal: Critical Care	Publication Date: Jan 1, 1999
Citations: 30	License type: cc-by

Affiliation: Marseille Public University Hospital System

Abstract

Community-acquired meningitis is associated with high morbidity and mortality. The epidemiology of community-acquired meningitis has changed over the past 15 years with the use of new vaccines and with the development of resistance to antibiotics. Bacterial meningitis would appear to be the most frequent by far, but most viral aetiologies are very often poorly recognized. The annual incidence of purulent community-acquired meningitis in France was estimated at 22 cases per million inhabitants in 1993. Age is a major risk factor in bacterial meningitis. The most affected group is children under 2 years of age, in whom the infection rate ranges from 10 to 110 cases per 100000 infants per year. Such cases must be considered as an absolute medical emergency. This review is limited to meningitis in immunocompetent patients.

Highlights

Community-acquired meningitis is associated with high morbidity and mortality
Teenagers and young adults, N. meningitidis and S. pneumoniae represent more than 80% of the cases
The increasing resistance of S. pneumoniae to penicillin has created a problem for therapy, which at present cannot be completely optimized and requires a knowledge of the sensitivity phenotype of the bacteria in question

Summary

Introduction

Community-acquired meningitis is associated with high morbidity and mortality. The epidemiology of communityacquired meningitis has changed over the past 15 years with the use of new vaccines and with the development of resistance to antibiotics. Treatment must be started immediately after the lumbar puncture and the initial blood culture, and sometimes before if the CSF examination has been deferred (patient far from a hospital, decision to perform a CT scan) and/or if the symptoms appear to be fulminant (fever at 40°C, meningeal syndrome and worsening level of consciousness in < 24 h or purpura; Fig. 1) [23]. In children under 3 months of age or in adults with risk factors for PRP and/or presenting with signs of severity, initial treatment must include a third-generation cephalosporin such as cefotaxime (300 mg/kg per day in four infusions) or ceftriaxone (70–100 mg/kg per day in one or two injections, maximum 4 g/day), and vancomycin (60 mg/kg per day either in four infusions of at least 1 h or in continuous infusion with an initial load of 15 mg/kg) [32]. This applies to pregnant women, immunocompromised subjects and the elderly

Richardson M

Findings

20. Calder JA