Abstract Details

Title Predictors of Poor Outcome in Adult Patients with Fulminant Bacterial Meningitis

Topic Infections/AIDS/Prion Disease

Presentation(s) P04 - (-)

Poster/Presentation
Number 017

Objective

Background BACKGROUND: Bacterial meningitis is associated with a high case fatality despite treatment with antibiotics. Intracranial and secondary medical comorbidities frequently lead to clinical deterioration. Recognition and directed therapy of these complications may lead to improved outcomes.

Design/Methods DESIGN/METHODS: Retrospective chart review identified patients with fulminant bacterial meningitis, defined as meningitis resulting in coma (Glasgow Coma Scale < 8) within 24-48 hours from hospitalization or death, at Mayo Clinic Rochester (Jan. 2000-Nov. 2010). Clinical data were retrieved from electronic medical records. Modified Rankin scale was calculated to assess patient outcomes at discharge.

Results RESULTS: Thirty-nine patients (ages 21-87) were identified. Most presented to the hospital after 2 days of symptoms and had encephalopathy (44%), coma (28%), seizures (3%) or a combination (26%) on admission. Average serum WBC on admission was 17 (range 2-46) and average CSF WBC was 6,498 (range 1-87,120). Positive blood cultures and/or CSF cultures were found in 28/38 patients (74%). The most common organism isolated was Streptococcus pneumoniae (57%, N=16), followed by Staphylococcus aureus (25%). Imaging (CT or MRI brain) was abnormal in 12/35 patients (34%). All patients were treated with broad spectrum antibiotics and 20/39 patients received steroids (75% given with first dose of antibiotics). Medical complications (sepsis, multisystem organ failure, MI) were seen in 23/39 patients (60%). Average mRS on discharge was 4 (range 1-6) and 16 patients died during hospitalization. Worse mRS on discharge was associated with older age (p=0.0199), low serum WBC (p=0.0125) and low CSF white cells (p=0.0012) at presentation, and medical complications (p=0.0061).

Conclusions CONCLUSIONS: Multiple comorbidities may lead to worse clinical outcomes in fulminant bacterial meningitis and therefore should be carefully documented and treated. Increasing age, and low serum and CSF WBC may also identify patients at risk.

Authors/Disclosures
Rajanandini Muralidharan, MD, FAAN (Winthrop Neuroscience) PRESENTER	Dr. Muralidharan has nothing to disclose.
Farrah J. Mateen, MD, PhD, FAAN (Northwestern University Department of Neurology)	Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from Amgen. The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.
Shane Raines	Shane Raines has received personal compensation for serving as an employee of 2b Analytics, LLC.

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