Use of Adjunctive Steroids and Incidence of Delayed Cerebral Venous Thrombosis in Adults with Bacterial Meningitis

Abstract

BackgroundBacterial meningitis is associated with significant morbidity and mortality. Adjunctive steroids decrease mortality in adults with meningitis due to Streptococcus pneumoniaebut its use has been recently linked to the development of delayed cerebral thrombosis (DCT). The purpose of our study was to determine the utilization of adjunctive steroids and its incidence.MethodsA retrospective multicenter study involving 10 Houston area hospitals from 2008 to 2016. Data was gathered from 120 adults with culture proven community-acquired bacterial meningitis. An adverse clinical outcome was defined as a Glasgow outcome score of 1–4.ResultsThere was a total of 120 patients enrolled; of which, 55% were male. Adjunctive intravenous steroids were administered in 82 (68%) patients with bacterial meningitis. The steroid median duration was 3.8 days. The average age of patients was 55.3 years (range 20–92). There was no difference in Charlson comorbidity score, immunosuppression, presence of sinusitis or otitis, fever, meningeal signs or symptoms, abnormal neurological findings, Gram stain or severity of illness, based on Aronin score (P > 0.05), between patients who received steroids and those that did not. Older patients, age >65, were less likely to receive adjunctive steroids (P = 0.028). The most common organism isolated was Streptococcus pneumoniae, which occurred in 46 (38%) patients. An adverse clinical outcome was seen in 46 (38%) patients with no difference between groups (P = 0.819). Delayed cerebral thrombosis was seen in a total of 9 (7.5%) patients with bacterial meningitis. Of these, 1 patient (2.6%) did not receive steroids and the remaining 8 (10.9%) patients received steroids (P = 0.158). Five cases of meningitis that were complicated by DCT were caused by Streptococcus pneumoniae, 1 by Listeria monocytogenes, and 2 with Staphylococcus aureus.ConclusionAdjunctive steroids are being used in the majority of adults with bacterial meningitis but it is possibly associated with DCT, a devastating complicationDisclosures All authors: No reported disclosures.