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Background <p>Community-acquired bacterial meningitis (CABM) is associated with high mortality and persistent disability. We aimed to assess changing trends in the initial management of patients requiring Intensive Care Unit (ICU) admission for CABM and their possible consequences on outcome over a period of fifteen years.</p> Methods <p>We performed a retrospective observational study in two french ICUs, including all patients with proven or probable CABM. Three periods were defined: period 1 (2005–2009), period 2 (2010–2014) and period 3 (2015–2019). The criteria studied were: the time from hospital admission (HA) to lumbar puncture (LP), the time from HA to the delivery of antibiotics, the time from HA to ICU admission, the head CT scan-LP sequence and the administration of dexamethasone. Recommendations from the French Infectious Diseases Society (FIDS) were used to assess the relevance of the head CT scan-LP sequence. The outcome was analyzed using in-ICU mortality and the Glasgow Outcome Scale (GOS) at three months.</p> Results <p>A total of 166 patients were included (51 patients during period 1, 61 during period 2 and 54 during period 3). The mean age was 57.2 ± 19.9 yrs and the mean Glasgow Coma Scale score on ICU admission was 10.5 ± 3.4. CABM was proven in 146 patients. The median time from HA to LP and antibiotics was respectively 4&#xa0;h [IQR 2-7.5] and 4.5&#xa0;h [IQR 1.75-8] with no significant difference between the three periods. Only 30 (22.2%) patients received appropriate antibiotics within 1&#xa0;h following HA. ICU admissions were faster during period 3 with a median time of 3&#xa0;h [IQR 0-8.5]. Dexamethasone was delivered more often during period 3 (80% of patients). The ICU mortality rate was 18.1% and remained unchanged over the three periods. A severe disability at three months was significantly lower during the third period with respectively, a GOS score 2–3 for 5 patients in period 1, 6 in period 2 and none in period 3.</p> Conclusion <p>The time for the delivery of appropriate antibiotics remains too high in our patients. Neurologic sequelae at three months have decreased without a significant change in in-ICU mortality.</p> Clinical trial number <p>Not applicable.</p>

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Initial management and outcome of community-acquired bacterial meningitis in two French ICUs over a period of fifteen years

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  • 发表日期：

    2025年11月25日

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  • Flore Baron,
  • Marion Houard,
  • Maxime Degrendel,
  • Patrick Devos,
  • Pierre-Yves Delannoy,
  • Saad Nseir,
  • Olivier Leroy,
  • Hugues Georges

摘要

Background

Community-acquired bacterial meningitis (CABM) is associated with high mortality and persistent disability. We aimed to assess changing trends in the initial management of patients requiring Intensive Care Unit (ICU) admission for CABM and their possible consequences on outcome over a period of fifteen years.

Methods

We performed a retrospective observational study in two french ICUs, including all patients with proven or probable CABM. Three periods were defined: period 1 (2005–2009), period 2 (2010–2014) and period 3 (2015–2019). The criteria studied were: the time from hospital admission (HA) to lumbar puncture (LP), the time from HA to the delivery of antibiotics, the time from HA to ICU admission, the head CT scan-LP sequence and the administration of dexamethasone. Recommendations from the French Infectious Diseases Society (FIDS) were used to assess the relevance of the head CT scan-LP sequence. The outcome was analyzed using in-ICU mortality and the Glasgow Outcome Scale (GOS) at three months.

Results

A total of 166 patients were included (51 patients during period 1, 61 during period 2 and 54 during period 3). The mean age was 57.2 ± 19.9 yrs and the mean Glasgow Coma Scale score on ICU admission was 10.5 ± 3.4. CABM was proven in 146 patients. The median time from HA to LP and antibiotics was respectively 4 h [IQR 2-7.5] and 4.5 h [IQR 1.75-8] with no significant difference between the three periods. Only 30 (22.2%) patients received appropriate antibiotics within 1 h following HA. ICU admissions were faster during period 3 with a median time of 3 h [IQR 0-8.5]. Dexamethasone was delivered more often during period 3 (80% of patients). The ICU mortality rate was 18.1% and remained unchanged over the three periods. A severe disability at three months was significantly lower during the third period with respectively, a GOS score 2–3 for 5 patients in period 1, 6 in period 2 and none in period 3.

Conclusion

The time for the delivery of appropriate antibiotics remains too high in our patients. Neurologic sequelae at three months have decreased without a significant change in in-ICU mortality.

Clinical trial number

Not applicable.