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Jaubert P, Charpentier J, Benghanem S, Cariou A, Pène F, Mira JP, Jozwiak M. Meningitis in critically ill patients admitted to intensive care unit for severe community-acquired pneumococcal pneumonia. Ann Intensive Care 2023; 13:129. [PMID: 38108904 PMCID: PMC10728423 DOI: 10.1186/s13613-023-01211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Although it has been reported that patients with pneumococcal pneumonia may develop meningitis, lumbar puncture is not systematically recommended in these patients, even in patients with associated bacteremia or invasive pneumococcal disease. The aim of this study was to determine the characteristics and outcomes of patients admitted to intensive care unit (ICU) for pneumococcal community-acquired pneumonia who developed meningitis. METHODS We retrospectively included all consecutive patients admitted to our ICU from January 2006 to December 2020 for severe pneumococcal community-acquired pneumonia according to American Thoracic Society criteria. Meningitis was defined as pleocytosis > 5 cells/mm3 or a positive culture of cerebrospinal fluid for Streptococcus pneumoniae in lumbar puncture. The primary endpoint was the proportion of patients with meningitis during their ICU stay. RESULTS Overall, 262 patients [64(52-75) years old] were included: 154(59%) were male, 80(30%) had chronic respiratory disease, 105(39%) were immunocompromised and 6(2%) were vaccinated against S. pneumoniae. A lumbar puncture was performed in 88(34%) patients with a delay from ICU admission to puncture lumbar of 10.5 (2.8-24.1) h and after the initiation of pneumococcal antibiotherapy in 81(92%) patients. Meningitis was diagnosed in 14 patients: 16% of patients with lumbar puncture and 5% of patients in the whole population. Patients with meningitis had more frequently human immunodeficiency virus positive status (29 vs. 5%, p = 0.02), neurological deficits on ICU admission (43 vs. 16%, p = 0.03) and pneumococcal bacteremia (71 vs. 30%, p < 0.01) than those without. The ICU mortality rate (14 vs. 13%, p = 0.73) and the mortality rate at Day-90 (21 vs. 15%, p = 0.83) did not differ between patients with and without meningitis. The proportion of patients with neurological disorders at ICU discharge was higher in patients with meningitis (64 vs. 23%, p < 0.001) than in those without. The other outcomes did not differ at ICU discharge, Day-30 and Day-90 between the two groups of patients. CONCLUSION Meningitis was diagnosed in 16% of patients with severe pneumococcal community-acquired pneumonia in whom a lumbar puncture was performed, was more frequent in patients with pneumococcal bacteremia and was associated with more frequent neurological disorders at ICU discharge. Further studies are needed to confirm these results.
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Affiliation(s)
- Paul Jaubert
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Julien Charpentier
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Sarah Benghanem
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université de Paris Cité, Paris, France
| | - Alain Cariou
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université de Paris Cité, Paris, France
| | - Frédéric Pène
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université de Paris Cité, Paris, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université de Paris Cité, Paris, France
| | - Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université de Paris Cité, Paris, France.
- UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
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Chekrouni N, Kroon M, Drost EHGM, van Soest TM, Bijlsma MW, Brouwer MC, van de Beek D. Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study. Ann Intensive Care 2023; 13:124. [PMID: 38055180 DOI: 10.1186/s13613-023-01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. METHODS We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1-4) by multivariable logistic regression. RESULTS A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49-69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. CONCLUSIONS The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.
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Affiliation(s)
- Nora Chekrouni
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merel Kroon
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Evelien H G M Drost
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Thijs M van Soest
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merijn W Bijlsma
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
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Van RN, Tubiana S, De Broucker T, Cédric J, Roy C, Meyohas MC, Prazuck T, Chirouze C, Hoen B, Duval X, Revest M. Persistent headaches one year after bacterial meningitis: prevalence, determinants and impact on quality of life. Eur J Clin Microbiol Infect Dis 2023; 42:1459-1467. [PMID: 37867184 DOI: 10.1007/s10096-023-04673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life. METHODS In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed. RESULTS Among the 277 alive patients at M12 87/274 (31.8%), 213/271 (78.6%) and 86/277 (31.0%) reported headaches before, at the onset, and at M12, respectively. In multivariate analysis, female sex (OR: 2.75 [1.54-4.90]; p < 0.001), pre-existing headaches before meningitis (OR: 2.38 [1.32-4.30]; p < 0.01), higher neutrophilic polynuclei percentage in the CSF of the initial lumbar puncture (OR: 1.02 [1.00-1.04]; p < 0.05), and brain abscess during the initial hospitalisation (OR: 8.32 [1.97-35.16]; p < 0.01) were associated with M12 persistent headaches. Neither the responsible microorganism, nor the corticoids use were associated with M12 persistent headaches. M12 neuro-functional disability (altered Glasgow Outcome Scale; p < 0.01), M12 physical handicap (altered modified Rankin score; p < 0.001), M12 depressive symptoms (p < 0.0001), and M12 altered physical (p < 0.05) and mental (p < 0.0001) qualities of life were associated with M12 headaches. CONCLUSION Persistent headaches are frequent one year after meningitis and are associated with quality of life alteration. CLINICAL TRIAL NCT01730690.
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Affiliation(s)
- Rémi Nguyen Van
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France
| | - Sarah Tubiana
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
| | | | | | - Carine Roy
- Epidemiology, Biostatistics and Clinical Research Unit, Bichat Claude Bernard Hospital, APHP, Paris, France
| | | | | | | | - Bruno Hoen
- Infectious Diseases Unit, CHU Nancy, France
| | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
- Centre d'investigation Clinique, Hôpital Bichat, APHP, Inserm CIC 1425, Paris, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France.
- UMR-1230 BRM (Bacterial RNA and Medicine), Inserm, Université Rennes, Rennes, France.
- Centre d'investigation Clinique, CHU Rennes, Inserm CIC 1414, Rennes, France.
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Artiaga A, Herman F, Arquizan C, Thouvenot E, Loubet P, Le Moing V, Picot MC, Makinson A. Cerebral vasculitis as a complication of pneumococcal meningitis: A cohort study. Infect Dis Now 2023; 53:104772. [PMID: 37619963 DOI: 10.1016/j.idnow.2023.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Cerebral vasculitis (CV) is a severe complication of pneumococcal meningitis (PM); whether dexamethasone use can reduce its occurrence remains to be determined. METHODS This is a retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020 in two tertiary hospitals. Extrapolating from a standardized definition of primary angiitis of the central nervous system, we defined CV as worsened neurological symptoms associated with compatible imaging. All images were analyzed by a radiologist, and two neurologists reviewed all inconclusive cases of suspected CV for adjudication. Factors associated with CV were analyzed, including dexamethasone use. A subgroup analysis was limited to patients with a lumbar puncture at PM diagnosis. RESULTS Among 168 patients with PM, 49 (29.2%) had CV, occurring after a median of 8 days (IQR 5-13) of PM diagnosis. In multivariate analysis (N = 151), initial CRP was associated with CV (OR 1.28 per 50-unit increase, p = 0.003), which was marginally linked with delayed hospital admission more than 48 hours after first symptoms (OR 2.39, p = 0.06) and prior NSAID intake (OR 2.94, p = 0.05). Dexamethasone administration did not impact CV occurrence. In 133 patients having undergone lumbar puncture, CSF protein level > 4.4 g/L (OR 4.50, p = 0.006) was associated with CV. CONCLUSIONS In our cohort, CV was a frequent and severe complication of PM, often occurring in association with unduly delayed medical care, high CRP at admission, and high levels of protein in CSF.
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Affiliation(s)
- Agathe Artiaga
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France
| | - Fanchon Herman
- Medical Information Department - University Hospital of Montpellier, France
| | - Caroline Arquizan
- Stroke Unit, Department of Neurology, University of Montpellier, France; Paris Descartes University, INSERM 1226, Paris, France
| | - Eric Thouvenot
- Neurology Department - University Hospital of Nimes, France; Functional Genomics Institute, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department - University Hospital of Nimes, France; Inserm U1047 University of Montpellier Nimes, France
| | - Vincent Le Moing
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Medical Information Department - University Hospital of Montpellier, France; Clinical Research and Epidemiology Unit, INSERM, Clinical Investigation Centre 1411, University of Montpellier, France
| | - Alain Makinson
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France.
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Thy M, de Montmollin E, Bouadma L, Timsit JF, Sonneville R. Severe meningoencephalitis: epidemiology and outcomes. Curr Opin Crit Care 2023; 29:415-422. [PMID: 37641514 DOI: 10.1097/mcc.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW This article aims to provide an updated review on the epidemiology and outcomes of severe meningoencephalitis. RECENT FINDINGS Meningoencephalitis is a critical medical condition characterized by inflammation in both the meninges and brain parenchyma. Bacterial, viral, or fungal infections are common causes, although noninfectious factors, such as autoimmune causes, can also contribute. In patients requiring intensive care, meningoencephalitis is associated with a severe prognosis, including mortality rates ranging from 11 to 25% and functional disability in 15-25% of survivors. Recent multicenter studies have identified several parameters linked to poor outcomes, including older age, immunocompromised status, focal neurologic signs, abnormal brain imaging, and delayed administration of antimicrobials. The use of new multiplex PCR techniques for diagnosis has generated debate based on recent data. Investigation is still needed to determine the effectiveness of adjunctive therapies, including seizure prophylaxis, and adjunctive steroids for nonbacterial causes. SUMMARY Recent multicenter studies have enhanced our understanding of the current epidemiology and outcomes of severe meningoencephalitis in adult patients.
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Affiliation(s)
- Michael Thy
- Department of Intensive Care Medicine
- Department of Infectious and Tropical Diseases, AP-HP, Bichat Hospital
- EA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women
| | - Etienne de Montmollin
- Department of Intensive Care Medicine
- INSERM UMR1137, IAME, Université de Paris Cité, Paris, France
| | - Lila Bouadma
- Department of Intensive Care Medicine
- INSERM UMR1137, IAME, Université de Paris Cité, Paris, France
| | - Jean-François Timsit
- Department of Intensive Care Medicine
- INSERM UMR1137, IAME, Université de Paris Cité, Paris, France
| | - Romain Sonneville
- Department of Intensive Care Medicine
- INSERM UMR1137, IAME, Université de Paris Cité, Paris, France
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Gaudin J, Thayalakulasingam T. Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect. Cureus 2023; 15:e44869. [PMID: 37814724 PMCID: PMC10560565 DOI: 10.7759/cureus.44869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Streptococcus pneumoniae is a leading cause of otitis media, pneumonia, sinusitis, and meningitis. This encapsulated, gram-positive bacterium colonizes the nasopharynx. Major risk factors, including age, hyposplenism, and immunosuppression, predispose to serious infections. Viral infections are known to increase the risk of secondary bacterial infections as the initial immune response can compromise defenses against bacteria. Coronavirus disease 2019 (COVID-19) similarly poses a risk for secondary bacterial infections and coinfections, such as invasive pneumococcal disease (IPD). Still, temporal relationships between IPD and COVID-19 are not fully understood. IPD may also be a complication of untreated acute otitis media. COVID-19 and pneumococcal bacteremia, a form of IPD, have both been shown to damage the blood-brain barrier and gain access to the central nervous system, resulting in deep infections, namely, meningitis and encephalitis. Presented here is the case of a 70-year-old female partially vaccinated against pneumococcal disease, who was initially evaluated for an elevated temperature, acute encephalopathy, and COVID-19. Further investigation confirmed IPD in the form of bacteremia and meningitis. The patient had a protracted disease course complicated by sick sinus syndrome and altered mental status, which led to the identification of otitis media and a right tegmen tympani defect. Emergent implantation of a single-chamber temporary pacemaker and myringotomy with tube placement was performed. Lumbar puncture showed evidence of meningitis. Antibiotic therapy eventually narrowed to ceftriaxone and continued for a total of six weeks. The presence of comorbidities, history of incomplete pneumococcal vaccination series, and concomitant infection with COVID-19 may explain the development of IPD and other complications seen in this case. Furthermore, tegmen tympani defects and damage to the blood-brain barrier can serve as a route for otogenic intracranial sepsis and meningitis. This case serves to reinforce the importance of pneumococcal vaccination and the high clinical suspicion necessary for the prompt diagnosis and treatment of IPD. However, despite vaccination, IPD remains a life-threatening disease due to poor antibiotic penetration in the central nervous system and overlapping presentations with coinfections, such as COVID-19.
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Affiliation(s)
- Julie Gaudin
- Internal Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
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Zhang L, Li W, Peng X, Jiang L, Hu Y. Clinical Features and a Prediction Nomogram for Prognosis in Children with Escherichia coli Meningitis. J Child Neurol 2023; 38:528-536. [PMID: 37574798 DOI: 10.1177/08830738231193217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND We aimed to build a prediction nomogram for early prediction of poor prognosis in children with Escherichia coli meningitis and analyzed the course of treatment and discharge criteria. METHODS Eighty-seven pediatric patients with E coli meningitis were retrospectively recruited from the Children's Hospital of Chongqing Medical University between June 2012 and November 2021. Univariate analysis and binary logistic analysis were used to evaluate the risk factors, and the prediction model was built. RESULTS E coli meningitis is more common in children <3 months old in our study (86.2%). Common complications were subdural effusion (39.1%), followed by hydrocephalus (13.8%) and repeated convulsions (12.6%). The mortality rate and sequelae rate of E coli meningitis in children was ∼10.9% and ∼6.3%, respectively. Univariate analysis showed that 13 clinical indicators were associated with poor prognosis of E coli meningitis in children. In binary logistic analysis, risk factors were seizures (P = .032) and the last cerebrospinal fluid glucose content before discharge (P = .002). A graphical nomogram was designed. The area under the receiver operating characteristic curve was 0.913. The Hosmer-Lemeshow test showed that the model was a good fit (P = .648). Internal validation proved the reliability of the prediction nomogram. CONCLUSIONS E coli meningitis is more common in children <3 months old in our study. The rate of complications and sequelae are high. The prediction nomogram could be used to assess the risk of poor prognosis in children with E coli meningitis by clinicians.
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Affiliation(s)
- Lingyu Zhang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wenjie Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoling Peng
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Chavanet P, Fournel I, Bourredjem A, Piroth L, Blot M, Sixt T, Binquet C. Addition of daptomycin for the treatment of pneumococcal meningitis: protocol for the AddaMAP study. BMJ Open 2023; 13:e073032. [PMID: 37491088 PMCID: PMC10373719 DOI: 10.1136/bmjopen-2023-073032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The leading cause of acute bacterial meningitis in adults is Streptococcus pneumoniae. This infection is associated with high rates of mortality and morbidity related, among other factors, to the excessive host response to the pneumococcal lysis. Experimental in vitro and in vivo data show that the combination of corticosteroids/third-generation cephalosporins and the non-lytic antibiotic, daptomycin, has synergistic effects with (1) a rapid cerebrospinal fluid sterilisation, (2) less brain damages and (3) less loss of cognitive performances. Despite these encouraging results, daptomycin has never been evaluated in adult patients with pneumococcal meningitis. METHODS AND ANALYSIS The AddaMAP trial is a phase II, open-label, Simon's two-stage, multicentre trial that has been designed to assess the efficacy and safety of adding daptomycin (10 mg/kg/d for 8 days) to the recommended treatment (corticosteroids+third generation cephalosporin) in adults with confirmed pneumococcal meningitis. The main endpoint is the disability-free survival (defined as modified Rankin Scale mRS≤2) at day 30. Secondary outcomes are overall mortality, disability at D30 and D90 (mRS, Glasgow Coma Scale and Glasgow Outcome Scales, mini-mental score), hearing loss (Hearing Handicap Inventory Test at D30 and D90, routine audiometric test and Hearing-it test at D30), and quality of life (12-item Short Form Survey and WHO QOL BREF). Seventy-two analysable patients are required. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board of the IDF 1 of the ethics committee on 16 January 2018, and authorisation was obtained from the Agence Nationale de Securité des Médicaments et des Produits de Santé on 22 September 2017. The results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03480191.
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Affiliation(s)
- Pascal Chavanet
- Infectious Diseases Department, University Hospital, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Isabelle Fournel
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
| | - Abderrahmane Bourredjem
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, Dijon, France
| | - Mathieu Blot
- Infectious Diseases Department, University Hospital, Dijon, France
| | - Thibault Sixt
- Infectious Diseases Department, University Hospital, Dijon, France
| | - Christine Binquet
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
- Centre d'Investigation Clinique, CHU Dijon, Dijon, France
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Benadji A, Debroucker T, Martin-Blondel G, Argaud L, Vitrat V, Biron C, Wolff M, Hoen B, Duval X, Tubiana S. Cerebrovascular complications in patients with community-acquired bacterial meningitis: occurrence and associated factors in the COMBAT multicenter prospective cohort. BMC Infect Dis 2023; 23:376. [PMID: 37277727 DOI: 10.1186/s12879-023-08320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Community-acquired bacterial meningitis is a rare but severe central nervous system infection that may be associated with cerebrovascular complications (CVC). Our objective is to assess the prevalence of CVC in patients with community-acquired bacterial meningitis and to determine the first-48 h factors associated with CVC. METHODS We analyzed data from the prospective multicenter cohort study (COMBAT) including, between February 2013 and July 2015, adults with community-acquired bacterial meningitis. CVC were defined by the presence of clinical or radiological signs (on cerebral CT or MRI) of focal clinical symptom. Factors associated with CVC were identified by multivariate logistic regression. RESULTS CVC occurred in 128 (25.3%) of the 506 patients in the COMBAT cohort (78 (29.4%) of the 265 pneumococcal meningitis, 17 (15.3%) of the 111 meningococcal meningitis, and 29 (24.8%) of the 117 meningitis caused by other bacteria). The proportion of patients receiving adjunctive dexamethasone was not statistically different between patients with and without CVC (p = 0.84). In the multivariate analysis, advanced age (OR = 1.01 [1.00-1.03], p = 0.03), altered mental status at admission (OR = 2.23 [1.21-4.10], p = 0.01) and seizure during the first 48 h from admission (OR = 1.90 [1.01-3.52], p = 0.04) were independently associated with CVC. CONCLUSIONS CVC were frequent during community-acquired bacterial meningitis and associated with advanced age, altered mental status and seizures occurring within 48 h from admission but not with adjunctive corticosteroids.
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Affiliation(s)
- Amine Benadji
- Inserm Clinical Investigation Center 1425, Bichat Hospital, APHP, 46, rue Henri Huchard, Paris, 75018, France
| | - Thomas Debroucker
- Department of Neurology, Pierre-Delafontaine Hospital, Saint-Denis, France
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, Toulouse Institute for Infectious and Inflammatory Diseases, University Hospital of Toulouse, INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Heriot Hospital, Lyon, France
- Lyon University, INSERM UMR1060 (CarMeN), Lyon, France
| | - Virginie Vitrat
- Department of infectious diseases, Annecy Genevois Hospital, Annecy, France
| | - Charlotte Biron
- Center for the Prevention of Infectious and Transmitted Diseases of the UHC of Nantes, Nantes, France
- Department of Infectious Diseases, INSERM, University Hospital Center of Nantes, Nantes, CIC 1413, France
| | - Michel Wolff
- Neuro-surgical Intensive Care Unit, Saint-Anne Hospital, Paris, France
| | - Bruno Hoen
- Department of infectious diseases, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Xavier Duval
- Inserm Clinical Investigation Center 1425, Bichat Hospital, APHP, 46, rue Henri Huchard, Paris, 75018, France
- Université Paris Cité, INSERM, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
| | - Sarah Tubiana
- Inserm Clinical Investigation Center 1425, Bichat Hospital, APHP, 46, rue Henri Huchard, Paris, 75018, France.
- Université Paris Cité, INSERM, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France.
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Fillatre P, Mailles A, Stahl JP, Tattevin P. Characteristics, management, and outcomes of patients with infectious encephalitis requiring intensive care: A prospective multicentre observational study. J Crit Care 2023; 77:154300. [PMID: 37207520 DOI: 10.1016/j.jcrc.2023.154300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE Infectious encephalitis (IE) is a severe disease which requires intensive care unit (ICU) admission in up to 50% of cases. We aimed to describe characteristics, management and outcomes of IE patients who required ICU admission. MATERIALS AND METHODS Ancillary study focusing on patients with ICU admission within the ENCEIF cohort, a French prospective observational multicentre study. The primary criteria for outcome was the functional status at hospital discharge, categorized using the Glasgow outcome scale (GOS). Logistic regression model was used to identify risk factors for poor outcome, defined as a GOS ≤ 3. RESULTS We enrolled 198 ICU patients with IE. HSV was the primary cause (n = 72, 36% of all IE, 53% of IE with microbiological documentation). Fifty-two patients (26%) had poor outcome at hospital discharge, including 22 deaths (11%). Immunodeficiency, supratentorial focal signs on admission, lower cerebrospinal fluid (CSF) white cells count (<75/mm3), abnormal brain imaging, and time from symptoms onset to acyclovir start >2 days were independent predictors of poor outcome. CONCLUSION HSV is the primary cause of IE requiring ICU admission. IE patients admitted in ICU have a poor prognosis with 11% of in-hospital mortality and 15% of severe disabilities in survivors at discharge.
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Affiliation(s)
- Pierre Fillatre
- Intensive care unit, Centre Hospitalier Yves Le Foll, Saint Brieuc, France; INSERM, CIC 1414, Rennes, France.
| | | | - Jean Paul Stahl
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Pierre Tattevin
- INSERM, CIC 1414, Rennes, France; Infectious diseases department, CHU Ponchaillou, Rennes, France
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11
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Iwata S, Hanada S, Takata M, Morozumi M, Kamei S, Ubukata K. Risk factors and pathogen characteristics associated with unfavorable outcomes among adults with pneumococcal meningitis in Japan, 2006 to 2016. J Infect Chemother 2023; 29:637-645. [PMID: 36907551 DOI: 10.1016/j.jiac.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE In this study, we aimed to clarify the risk factors associated with unfavorable outcomes in adults with pneumococcal meningitis (PnM). METHODS Surveillance was conducted between 2006 and 2016. Adults with PnM (n = 268) were followed up for outcomes within 28 days after admission using the Glasgow Outcome Scale (GOS). After classifying the patients into the unfavorable (GOS1-4) and favorable (GOS5) outcome groups, i) the underlying diseases, ii) biomarkers at admission, and iii) serotype, genotype, and antimicrobial susceptibility for all isolates were compared between both groups. RESULTS Overall, 58.6% of patients with PnM survived,15.3% died, and 26.1% had sequelae. The number of living days in the GOS1 group was highly heterogeneous. Motor dysfunction, disturbance of consciousness, and hearing loss were the commonest sequelae. Of the underlying diseases identified in 68.9% of the PnM patients, liver and kidney diseases were significantly associated with unfavorable outcomes. Of the biomarkers, creatinine and blood urea nitrogen, followed by platelet and C-reactive protein had the most significant associations with unfavorable outcomes. There was a significant difference in the high protein concentrations in the cerebrospinal fluid between the groups. Serotypes 23F, 6C, 4, 23A, 22F, 10A, and 12F were associated with unfavorable outcomes. These serotypes were not penicillin-resistant isolates possessing three abnormal pbp genes (pbp1a, 2x, and 2b), except for 23F. The expected coverage rate of the pneumococcal conjugate vaccine (PCV) was 50.7% for PCV15 and 72.4% for PCV20. CONCLUSIONS In the introduction of PCV for adults, the risk factors for underlying diseases should be prioritized over age, and serotypes with unfavorable outcomes should be considered.
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Affiliation(s)
- Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan; Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
| | - Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Misako Takata
- Department of Microbiology, Tokyo Medical University, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Kamei
- Center for Neuro-Infections, Ageo Central General Hospital, Saitama Pref, Japan
| | - Kimiko Ubukata
- Department of Microbiology, Tokyo Medical University, Japan; Department of General Medicine, Keio University School of Medicine, Tokyo, Japan
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Pajor MJ, Long B, Koyfman A, Liang SY. High risk and low prevalence diseases: Adult bacterial meningitis. Am J Emerg Med 2023; 65:76-83. [PMID: 36592564 DOI: 10.1016/j.ajem.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/19/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Acute bacterial meningitis in adults is a rare but serious condition that carries a high rate of morbidity. OBJECTIVE This review highlights pearls and pitfalls of acute bacterial meningitis in adults, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Meningitis encompasses a broad spectrum of disease involving inflammation of the meninges and subarachnoid space. It classically presents with fever, nuchal rigidity, and altered mental status, but this triad is not present in all cases. Up to 95% of patients will have at least two of the following four cardinal symptoms: fever, nuchal rigidity, altered mental status, and headache. The most common bacterial etiologies are S. pneumoniae and N. meningitidis. Cerebrospinal fluid testing obtained by lumbar puncture remains the gold standard in diagnosis. Head computed tomography prior to lumbar puncture may not be necessary in most patients. Empiric treatment consists of vancomycin, ceftriaxone, and dexamethasone. Elevated intracranial pressure should be managed using established neurocritical care strategies. CONCLUSION A better understanding of the pearls and pitfalls of acute bacterial meningitis can assist emergency clinicians in pursuing its timely diagnosis and management.
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Affiliation(s)
- Michael J Pajor
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Stephen Y Liang
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Alam AM, Easton A, Bavikatte G, Mahendran S, Michael BD. Sequelae of neurological infection: management in primary care. Trends Urol & Men's Health 2023. [DOI: 10.1002/tre.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ali M Alam
- Institute of Infection, Veterinary and Ecological Science University of Liverpool UK
- Barts Health NHS Trust London UK
| | | | | | | | - Benedict D Michael
- Institute of Infection, Veterinary and Ecological Science University of Liverpool UK
- The Walton Centre NHS Foundation Trust Liverpool UK
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Lu L, Li T, Chen H, Zhang L, Chen M, Peng Q, Qin X. Meningitis patients with pneumonia: correlation between blood parameters and clinical features. Biomark Med 2022; 16:1269-1278. [PMID: 36861490 DOI: 10.2217/bmm-2022-0565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: This research aimed to explore the possible relationship between the main experimental parameters and clinical status in meningitis patients with pneumonia infection. Methods: A retrospective analysis of the demographic characteristics, clinical features and laboratory parameters of meningitis patients was performed. Results: D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) exhibited good diagnostic ability for meningitis complicated with pneumonia. Additionally, we observed a positive correlation between D-dimer and CRP in cases of meningitis with pneumonia infection. D-dimer, ESR and Streptococcus pneumoniae (S. pneumoniae) were independently associated with meningitis patients with pneumonia infection. Conclusion: D-dimer, CRP, ESR and S. pneumoniae infection may effectively anticipate disease progression and adverse consequences in meningitis patients with pneumonia infection.
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Affiliation(s)
- Liuyi Lu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Taijie Li
- Department of Laboratory Medicine, Wuming Hospital of Guangxi Medical University, Nanning, 530199, Guangxi, China
| | - Huaping Chen
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Linyan Zhang
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Mingxing Chen
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qiliu Peng
- Department of Clinical Laboratory, Guangxi International Zhuang Medicine Hospital, Nanning, 530201, Guangxi, China
| | - Xue Qin
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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Morsli M, Boudet A, Kerharo Q, Stephan R, Salipante F, Dunyach-Remy C, Houhamdi L, Fournier PE, Lavigne JP, Drancourt M. Real-time metagenomics-based diagnosis of community-acquired meningitis: A prospective series, southern France. EBioMedicine 2022; 84:104247. [PMID: 36087524 PMCID: PMC9463524 DOI: 10.1016/j.ebiom.2022.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Point-Of-Care (POC) diagnosis of life-threatening community-acquired meningitis currently relies on multiplexed RT-PCR assays, that lack genotyping and antibiotic susceptibility profiling. We assessed the usefulness of real-time metagenomics (RTM) directly applied to the cerebrospinal fluid (CSF) for the identification, typing and susceptibility profiling of pathogens responsible for community-acquired meningitis. METHODS A series of 52 CSF samples from patients suspected of having community-acquired meningitis, were investigated at POC by direct RTM in parallel to routine real-time multiplex PCR (RT-PCR) and bacterial culture, for the detection of pathogens. RTM-generated sequences were blasted in real-time against an in-house database incorporating the panel of 12 most prevalent pathogens and against NCBI using EPI2ME online software, for pathogen identification. In-silico antibiogram and genotype prediction were determined using the ResFinder bio-tool and MLST online software. FINDINGS Over eight months, routine multiplex RT-PCR yielded 49/52 positive CSFs, including 21 Streptococcus pneumoniae, nine Neisseria meningitidis, eight Haemophilus influenzae, three Streptococcus agalactiae, three Herpesvirus-1, two Listeria monocytogenes, and one each of Escherichia coli, Staphylococcus aureus and Varicella-Zoster Virus. Parallel RTM agreed with the results of 47/52 CSFs and revealed two discordant multiplex RT-PCR false positives, one H. influenzae and one S. pneumoniae. Both multiplex RT-PCR and RTM agreed on the negativity of three CSFs. While multiplex RT-PCR routinely took 90 min, RTM took 120 min, although the pipeline analysis detected the pathogen genome after 20 min of sequencing in 33 CSF samples; and after two hours in 14 additional CSFs; yielding > 50% genome coverage in 19 CSFs. RTM identified 14 pathogen genotypes, including a majority of H. influenzae b, N. meningitidis B and S. pneumoniae 11A and 3A. In all 16 susceptible cultured bacteria, the in-silico antibiogram agreed with the in-vitro antibiogram in 10 cases, available within 48 h in routine bacteriology. INTERPRETATION In addition to pathogen detection, RTM applied to CSF samples offered supplementary information on bacterial profiling and genotyping. These data provide the proof-of-concept that RTM could be implemented in a POC laboratory for one-shot diagnostic and genomic surveillance of pathogens responsible for life-threatening meningitis. FUNDING This work was supported by the French Government under the Investments in the Future programme managed by the National Agency for Research reference: Méditerranée Infection 10-IAHU-03.
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Affiliation(s)
- Madjid Morsli
- IHU Méditerranée Infection, Marseille, France; IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, France
| | - Agathe Boudet
- VBIC, INSERM U 1047, Université de Montpellier, France; Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | - Quentin Kerharo
- IHU Méditerranée Infection, Marseille, France; Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Marseille, IHU, Méditerranée Infection, Marseille, France
| | - Robin Stephan
- Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | - Florian Salipante
- Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France; Service de Biostatistique, Epidémiologie, Santé Publique, Innovation en Méthodologie, CHU Nîmes, Nîmes, France
| | - Catherine Dunyach-Remy
- VBIC, INSERM U 1047, Université de Montpellier, France; Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | | | - Pierre-Edouard Fournier
- IHU Méditerranée Infection, Marseille, France; VITROME, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France
| | - Jean Philippe Lavigne
- VBIC, INSERM U 1047, Université de Montpellier, France; Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | - Michel Drancourt
- IHU Méditerranée Infection, Marseille, France; IRD, MEPHI, IHU Méditerranée Infection, Aix-Marseille-Université, France; Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Marseille, IHU, Méditerranée Infection, Marseille, France.
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Akroum S, Tubiana S, de Broucker T, Dournon N, Varon E, Ploy MC, Mourvillier B, Oziol E, Lacassin F, Laurichesse H, Hoen B, Duval X, Burdet C. Long-term neuro-functional disability in adult patients with community-acquired bacterial meningitis. Infection 2022; 50:1363-1372. [PMID: 35657529 DOI: 10.1007/s15010-022-01855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the prevalence of neuro-functional disability and its determinants 12 months after community-acquired bacterial meningitis (CABM) in adult patients. METHODS In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM were enrolled and followed up for 12 months. Neuro-functional disability at 12 months was evaluated using a combination of the Glasgow Outcome Scale (functional disability), and the modified Rankin Disability Scale (physical disability). Factors associated with neuro-functional disability were identified by multivariate logistic regression. RESULTS Among 281 patients, 84 (29.9%) patients exhibited neuro-functional disability at 12 months: 79 (28.1%) with functional disability and 51 (18.1%) with physical disability. Overall, 6 patients (2.1%) died during the follow-up. The most common pathogen identified was Streptococcus pneumoniae (131/272, 48.2%); 77/268 patients (28.7%) had a physical disability at hospital discharge. Factors independently associated with 12-month neuro-functional disability were a pneumococcal meningitis (adjusted OR = 2.8; 95% confidence interval (CI) = [1.3; 6.7]), the presence of a physical disability at hospital discharge (aOR = 2.3; 95%CI = [1.2; 4.4]) and the presence of behavioral disorders at hospital-discharge (aOR = 5.9; 95%CI = [1.6; 28.4]). Dexamethasone use was not significantly associated with neuro-functional disability (OR = 0.2; 95%CI = [< 0.1;1.3]). CONCLUSION Neuro-functional disability is frequently reported 12 months after CABM. Detailed neurological examination at discharge is needed to improve the follow-up. TRIAL REGISTRATION NCT01730690.
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Affiliation(s)
- Souade Akroum
- Centre d'Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital Bichat, Inserm CIC 1425, 46, rue Henri Huchard, 75018, Paris, France
| | - Sarah Tubiana
- Centre d'Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital Bichat, Inserm CIC 1425, 46, rue Henri Huchard, 75018, Paris, France.,Université Paris Cité, IAME, INSERM, 75018, Paris, France.,Centre de Ressources Biologiques, AP-HP, Hôpital Bichat, 75018, Paris, France
| | | | - Nathalie Dournon
- Service de maladies infectieuses et tropicales, dermatologie, médecine interne, Centre Hospitalier Universitaire de Pointe-à-Pitre, 97159, Pointe-à-Pitre, France
| | - Emmanuelle Varon
- Centre Hospitalier Intercommunal de Créteil, Centre National de Référence des Pneumocoques, 94010, Créteil, France
| | - Marie Cécile Ploy
- Centre Hospitalier Universitaire de Limoges, Observatoire Régional des Pneumocoques, 87000, Limoges, France
| | - Bruno Mourvillier
- Service de Médecine Intensive et Réanimation Polyvalente, CHU Reims, 51100, Reims, France
| | - Eric Oziol
- Service de Médecine Interne, Centre Hospitalier de Béziers, 34500, Béziers, France
| | - Flore Lacassin
- Service de Médecine Interne, Centre Hospitalier Territorial de Nouméa, 98849, Nouméa, France
| | - Henri Laurichesse
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, CHU de Nancy, Hôpitaux de Brabois, 54511, Vandoeuvre-lès-Nancy, France
| | - Xavier Duval
- Centre d'Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital Bichat, Inserm CIC 1425, 46, rue Henri Huchard, 75018, Paris, France. .,Université Paris Cité, IAME, INSERM, 75018, Paris, France.
| | - Charles Burdet
- Centre d'Investigation Clinique, Hôpital Bichat Claude Bernard, AP-HP, Hôpital Bichat, Inserm CIC 1425, 46, rue Henri Huchard, 75018, Paris, France.,Université Paris Cité, IAME, INSERM, 75018, Paris, France.,Département d'Epidémiologie, Biostatistique et Recherche, AP-HP, Hôpital Bichat, 75018, Paris, France
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Duval X, Taha MK, Lamaury I, Escaut L, Gueit I, Manchon P, Tubiana S, Hoen B; COMBAT study group. One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study. Adv Ther 2022; 39:3031-41. [PMID: 35484469 DOI: 10.1007/s12325-022-02149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION COMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year. METHODS Patients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis. RESULTS Five of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients' disability scores from hospital discharge to 12 months (p = 0.16), but about 10% of the patients had residual disability. CONCLUSIONS Although most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination. TRIAL REGISTRATION ClinicalTrial.Gov identification number NCT01730690.
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Béraud G, Tubiana S, Erpelding ML, Le Moing V, Chirouze C, Gorenne I, Manchon P, Tattevin P, Vernet V, Varon E, Hoen B, Duval X. Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed? Infect Dis Ther 2022; 11:1521-1540. [PMID: 35618954 PMCID: PMC9334461 DOI: 10.1007/s40121-022-00651-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM). Methods We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only. Results Among the 1030 included patients, we identified 42 patients with IE–BM (4.1%). Baseline characteristics of patients with IE–BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE (14/30, 46.7%). Three-month mortality was 28.6% in patients with IE–BM, 20.5% in patients with IE, and 16.6% in patients with BM. Conclusions Patients with pneumococcal IE or altered mental status during IE must be investigated for BM. Patients with S. aureus, oral and group D streptococcal or enterococcal BM, or unfavorable outcome in pneumococcal meningitis would benefit from an echocardiography. Patients with the dual infection have the worst prognosis. Their identification is mandatory to initiate appropriate treatment.
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Affiliation(s)
- Guillaume Béraud
- Médecine Interne et Maladies Infectieuses, University Hospital of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.
| | - Sarah Tubiana
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, 75018, Paris, France.,Université de Paris, IAME, INSERM, 75018, Paris, France
| | - Marie-Line Erpelding
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Vincent Le Moing
- Département de Maladies Infectieuses et Tropicales, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Catherine Chirouze
- Maladies infectieuses et tropicals, Centre Hospitalier Régional Universitaire, 25030, Besançon, France.,UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Isabelle Gorenne
- AP-HP CHU Xavier Bichat, Département d'Épidémiologie et Recherche Clinique, INSERM CIC-EC 1425, 75018, Paris, France
| | - Pauline Manchon
- AP-HP CHU Xavier Bichat, Département d'Épidémiologie et Recherche Clinique, INSERM CIC-EC 1425, 75018, Paris, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, Rennes, France
| | | | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Bruno Hoen
- CHU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Vandœuvre-lès-Nancy, France
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, 75018, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,Inserm UMR-1137 IAME, Paris, France.,Paris Université, UFR de Médecine-Bichat, Paris, France
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20
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Moussiegt A, Birgy A, Cointe A, Duval X, Bidet P, Bonacorsi S. Escherichia coli community-acquired meningitis in adults: a case series of 29 patients in France. Clin Microbiol Infect 2022:S1198-743X(22)00232-4. [PMID: 35568305 DOI: 10.1016/j.cmi.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
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21
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Persson F, Bjar N, Hermansson A, Gisselsson-Solen M. Hearing loss after bacterial meningitis, a retrospective study. Acta Otolaryngol 2022; 142:298-301. [PMID: 35404758 DOI: 10.1080/00016489.2022.2058708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hearing loss is a common sequela after bacterial meningitis, but risk factors for this are poorly studied, particularly in relation to concurrent acute otitis media (AOM). AIMS The aim of this study was to investigate incidence and risk factors for hearing loss in patients treated for bacterial meningitis. METHODS In this retrospective study, medical records for patients admitted to hospital with bacterial meningitis in Skåne county, Sweden, between 2000 and 2017 were retrieved. The association between risk factors and hearing loss was estimated using logistic regression. RESULTS During the 18 years, 187 cases of meningitis were identified. Hearing loss was confirmed in 71 of the 119 patients who had done an audiometry. It was significantly more common in adults. There was also evidence of an association between hearing loss and AOM, and between hearing loss and pneumococcal infection. CONCLUSION Age, concurrent AOM and pneumococcal infection were risk factors for developing hearing loss. Despite being recommended in the national guidelines, more than a third of the patients had not done a hearing test after recovering from bacterial meningitis. The findings strengthen the demand for prompt ear examination and - if needed - tympanocentesis in meningitis patients.
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Affiliation(s)
| | - Nora Bjar
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Ann Hermansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
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22
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Gong Z, Zhang C, Li Y, Jing L, Duan R, Yao Y, Teng J, Jia Y. NLRP3 in the Cerebrospinal Fluid as a Potential Biomarker for the Diagnosis and Prognosis of Community-Acquired Bacterial Meningitis in Adults. Front Cell Infect Microbiol 2022; 11:803186. [PMID: 35145923 PMCID: PMC8823704 DOI: 10.3389/fcimb.2021.803186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To discover the levels of NLR family pyrin domain-containing 3 (NLRP3) in the cerebrospinal fluid (CSF) from adult patients with community-acquired bacterial meningitis (CABM). Methods We enrolled 34 patients with CABM, 20 patients with viral meningitis (VM), and 25 patients with non-inflammatory neurological disease. Data on standard clinical parameters, scores, and outcomes were obtained from clinical records, and inflammasome levels in the CSF were measured by an enzyme-linked immunosorbent assay. The area under the receiver operating characteristic curve (AUROC) was used to quantify the diagnostic and prognostic performance of CSF NLRP3 as a biomarker of CABM. Results The levels of NLRP3 were elevated in the CSF of patients with CABM, but levels for ASC, caspase-1, or other inflammasomes did not vary significantly. CSF NLRP3 was positively correlated with clinical severity and with the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte count, albumin quotient (Qalb), and immunoglobulin G quotient (QIgG). Patients with unfavorable outcomes had higher levels of NLRP3 in the CSF, which were correlated with several blood indicators, including NLR, PLR, and lymphocyte and monocyte counts. Conclusions Our results suggested that the level of CSF NLRP3 could represent the severity of CABM in adults. CSF NLRP3 may be a good biomarker for the diagnosis of CABM and for the discrimination between CABM and VM. It may also be a better biomarker for predicting the prognosis of adult patients with CABM when compared to the NLR or the lymphocyte and monocyte counts.
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Affiliation(s)
- Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chaopeng Zhang
- Department of Neurology, The Peoples’ Hospital of Dengfeng, Dengfeng, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Jing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yanjie Jia,
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Ungureanu A, van der Meer J, Bicvic A, Abbuehl L, Chiffi G, Jaques L, Suter-Riniker F, Leib SL, Bassetti CLA, Dietmann A. Meningitis, meningoencephalitis and encephalitis in Bern: an observational study of 258 patients. BMC Neurol 2021; 21:474. [PMID: 34872509 PMCID: PMC8647376 DOI: 10.1186/s12883-021-02502-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/25/2021] [Indexed: 12/05/2022] Open
Abstract
Background Depending on geographic location, causes of encephalitis, meningoencephalitis and meningitis vary substantially. We aimed to identify the most frequent causes, clinical presentation and long-term outcome of encephalitis, meningoencephalitis and meningitis cases treated in the Inselspital University Hospital Bern, Switzerland. Methods In this monocentric, observational study, we performed a retrospective review of clinical patient records for all patients treated within a 3-year period. Patients were contacted for a telephone follow-up interview and to fill out questionnaires, especially related to disturbances of sleep and wakefulness. Results We included 258 patients with the following conditions: encephalitis (18%), nonbacterial meningoencephalitis (42%), nonbacterial meningitis (27%) and bacterial meningoencephalitis/meningitis (13%). Herpes simplex virus (HSV) was the most common cause of encephalitis (18%); tick-borne encephalitis virus (TBEV) was the most common cause of nonbacterial meningoencephalitis (46%), enterovirus was the most common cause of nonbacterial meningitis (21%) and Streptococcus pneumoniae was the most common cause of bacterial meningoencephalitis/meningitis (49%). Overall, 35% patients remained without a known cause. After a median time of 16 months, 162 patients participated in the follow-up interview; 56% reported suffering from neurological long-term sequelae such as fatigue and/or excessive daytime sleepiness (34%), cognitive impairment and memory deficits (22%), headache (14%) and epileptic seizures (11%). Conclusions In the Bern region, Switzerland, TBEV was the overall most frequently detected infectious cause, with a clinical manifestation of meningoencephalitis in the majority of cases. Long-term neurological sequelae, most importantly cognitive impairment, fatigue and headache, were frequently self-reported not only in encephalitis and meningoencephalitis survivors but also in viral meningitis survivors up to 40 months after acute infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02502-3.
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Affiliation(s)
- Anamaria Ungureanu
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Antonela Bicvic
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Lena Abbuehl
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Gabriele Chiffi
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
| | - Léonore Jaques
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | | | - Stephen L Leib
- Institute for Infectious Disease, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland
| | - Anelia Dietmann
- Department of Neurology, University Hopsital and University of Bern, Inselspital, Bern, Switzerland.
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Abstract
PURPOSE OF REVIEW Central nervous system (CNS) infections such as ventriculitis and meningitis are associated with significant morbidity and mortality. In part, this may be due to increased difficulties in achieving a therapeutic antibiotic concentration at the site of infection due to both the pharmacokinetic (PK) changes observed during critical illness and the reduced antibiotic penetration through the blood brain barrier. This paper reviews the pharmacodynamics (PD) and CNS PKs of antibiotics used for Gram-negative bacterial CNS infections to provide clinicians with practical dosing advice. RECENT FINDINGS Recent PK studies have shown that currently used intravenous antibiotic dosing regimens may not achieve a therapeutic exposure within the CNS, even for reportedly 'susceptible' bacteria per the current clinical meningitis breakpoints. Limited data exist for new β-lactam antibiotic/β-lactamase inhibitor combinations, which may be required for multidrug resistant infections. Intraventricular antibiotic administration, although not a new concept, has further evidence demonstrating improved patient outcomes compared with intravenous therapy alone, despite the ongoing paucity of PK studies guiding dosing recommendations. SUMMARY Clinicians should obtain the bacterial minimum inhibitory concentration when treating patients with CNS Gram-negative bacterial infections and consider the underlying PK/PD principles when prescribing antibiotics. Therapeutic drug monitoring, where available, should be considered to guide dosing. Intraventricular therapy should also be considered for patients with ventricular drains to optimise clinical outcomes.
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25
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Bodilsen J, Larsen L, Brandt CT, Wiese L, Hansen BR, Andersen CØ, Lüttichau HR, Helweg-Larsen J, Storgaard M, Nielsen H. Existing Data Sources for Clinical Epidemiology: The Danish Study Group of Infections of the Brain Database (DASGIB). Clin Epidemiol 2021; 13:921-933. [PMID: 34675681 PMCID: PMC8500496 DOI: 10.2147/clep.s326461] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
Central nervous system (CNS) infections are rare diseases that are associated with considerable morbidity and mortality. Increased knowledge based on contemporary data is a prerequisite for improved management and prevention of these serious conditions. Yet, population-based databases of patients hospitalized with CNS infections remain scarce. The Danish Study Group of Infections of the Brain (DASGIB) has prospectively registered information on all adults ≥18 years of age admitted with CNS infections at departments of infectious diseases in Denmark since 2015. The main variables collected are baseline demographics, blood and cerebrospinal fluid tests, imaging results, and outcome using the Glasgow Outcome Scale score. To investigate important aspects for each type of CNS infections, additional variables are included specifically for bacterial meningitis, viral meningitis, encephalitis, brain abscess, neurosyphilis, and Lyme neuroborreliosis. From 2015 to 2020, a total of 3579 cases of CNS infections have been recorded in the DASGIB database. Using the unique civil registration number assigned to all Danish residents, the database can be unambiguously linked with nationwide healthcare registries at the individual level. This enables researchers to conduct detailed population-based and longitudinal observational studies of risk and prognosis of CNS infections and to compare them with matched population cohorts. The database is well-suited for epidemiological research and the DASGIB network forms a solid infrastructure for future national and international collaborations.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, 5000, Denmark
| | - Christian Thomas Brandt
- Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, 3400, Denmark.,Department of Infectious Diseases, Sjælland University Hospital, Roskilde, 4000, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, 4000, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, 2650, Denmark
| | | | - Hans Rudolf Lüttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, 2730, Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, 8200, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
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26
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Hemmati N, Nikkhahi F, Javadi A, Eskandarion S, Marashi SMA. Use of a new multiplex quantitative polymerase chain reaction based assay for simultaneous detection of Neisseria meningitidis, Escherichia coli K1 , Streptococcus agalactiae, and Streptococcus pneumoniae. Iran J Microbiol 2021; 13:464-469. [PMID: 34557274 PMCID: PMC8421586 DOI: 10.18502/ijm.v13i4.6970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Neisseria meningitidis, Escherichia coli K1, Streptococcus agalactiae, and Streptococcus pneumoniae cause 90% of bacterial meningitis. Almost all infected people die or have irreversible neurological complications. Therefore, it is essential to have a diagnostic kit with the ability to quickly detect these fatal infections. Materials and Methods The project involved 212 patients from whom cerebrospinal fluid samples were obtained. After total genome extraction and performing multiplex quantitative polymerase chain reaction (qPCR), the presence or absence of each infectious factor was determined by comparing with standard strains. Results The specificity, sensitivity, positive predictive value, and negative predictive value calculated were 100%, 92.9%, 50%, and 100%, respectively. So, due to the high specificity and sensitivity of the designed primers, they can be used instead of bacterial culture that takes at least 24 to 48 hours. Conclusion The remarkable benefit of this method is associated with the speed (up to 3 hours) at which the procedure could be completed. It is also worth noting that this method can reduce the personnel unintentional errors which may occur in the laboratory. On the other hand, as this method simultaneously identifies four common factors that cause bacterial meningitis, it could be used as an auxiliary method diagnostic technique in laboratories particularly in cases of emergency medicine.
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Affiliation(s)
- Nastaran Hemmati
- Student Research Committee, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farhad Nikkhahi
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amir Javadi
- Department of Community Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sahar Eskandarion
- Department of Pediatric Medicine, Imam Hossein Hospital, Iran University of Medical Sciences, Tehran, Iran
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27
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Benadji A, Duval X, Danis K, Hoen B, Page B, Béraud G, Vernet-Garnier V, Strady C, Brieu N, Maulin L, Roy C, Ploy MC, Gaillat J, Varon E, Tubiana S. Relationship between serotypes, disease characteristics and 30-day mortality in adults with invasive pneumococcal disease. Infection 2021; 50:223-233. [PMID: 34468953 DOI: 10.1007/s15010-021-01688-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. METHODS This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. RESULTS Among the 771 enrolled patients (median age 66 years, IQR [52.0-79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%; p < 0.001). The overall 30-day mortality was 16.7% and patients with concurrent meningitis and extra-cerebral IPD had the highest 30-day mortality rate (26.5%). On multivariate analyses, older age, history of malignant solid tumor, meningeal IPD and serotypes previously identified with high mortality potential were independently associated with 30-day mortality. Of the serotypes with high mortality potential, 80% were included in licensed (PCV13 or PPV23) vaccines. CONCLUSION We observed an effect of both host factors and pneumococcal serotypes on 30-day mortality in IPD. This highlights the need for a focused strategy to vaccinate at-risk patients. CLINICAL TRIAL ClinicalTrial. Gov identification number: NCT01730690.
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Affiliation(s)
- Amine Benadji
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France
| | - Xavier Duval
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France. .,IAME, INSERM, Université de Paris, 75018, Paris, France.
| | - Kostas Danis
- Santé Publique France, The French National Public Health Agency, Saint Maurice, France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, University Hospital Nancy, Hôpitaux de Brabois, 54511, Vandoeuvre-lès-Nancy, France
| | - Bernard Page
- AP-HP, Intensive Care Unit, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Guillaume Béraud
- Médecine Interne et Maladies Infectieuses, CHU de Poitiers, 86021, Poitiers, France
| | | | - Christophe Strady
- Cabinet d'Infectiologie, Clinique Courlancy, Groupe Courlancy-Reims, Reims, France
| | | | - Laurence Maulin
- Infectiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Carine Roy
- AP-HP, Unité de Recherche Clinique, Paris Nord, Hôpital Bichat, Paris, France
| | - Marie-Cécile Ploy
- Regional Observatories for Pneumococci (Observatoires Régionaux du Pneumocoque), University Hospital Centre Limoges, Limoges, France.,INSERM, CHU Limoges, RESINFIT, University of Limoges, U1092, F-87000, Limoges, France
| | | | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Sarah Tubiana
- AP-HP, Centre d'Investigation Clinique, Inserm CIC 1425, Hôpital Bichat Claude Bernard, 46, Rue Henri Huchard, 75018, Paris, France.,IAME, INSERM, Université de Paris, 75018, Paris, France
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Michalski D, Jungk C, Brenner T, Dietrich M, Nusshag C, Reuß CJ, Fiedler MO, Bernhard M, Beynon C, Weigand MA. [Focus on neurological intensive care medicine. Intensive care studies from 2020/2021]. Anaesthesist 2021; 70:706-13. [PMID: 34191035 DOI: 10.1007/s00101-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/10/2022]
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Csipo T, Cassidy BR, Balasubramanian P, Drevets DA, Ungvari ZI, Yabluchanskiy A. Endothelial Dysfunction and Impaired Neurovascular Coupling Responses Precede Cognitive Impairment in a Mouse Model of Geriatric Sepsis. Front Aging Neurosci 2021; 13:644733. [PMID: 34054502 PMCID: PMC8160114 DOI: 10.3389/fnagi.2021.644733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
Sepsis is a life-threatening condition, the incidence of which is significantly increased in elderly patients. One of the long-lasting effects of sepsis is cognitive impairment defined as a new deficit or exacerbation of preexisting deficits in global cognition or executive function. Normal brain function is dependent on moment-to-moment adjustment of cerebral blood flow to match the increased demands of active brain regions. This homeostatic mechanism, termed neurovascular coupling (NVC, also known as functional hyperemia), is critically dependent on the production of vasodilator NO by microvascular endothelial cells in response to mediators released from activated astrocytes. The goal of this study was to test the hypothesis that sepsis in aging leads to impairment of NVC responses early after treatment and that this neurovascular dysfunction associates with impairments in cognitive performance and vascular endothelial dysfunction. To test this hypothesis, we used a commonly studied bacterial pathogen, Listeria monocytogenes, to induce sepsis in experimental animals (males, 24 months of age) and subjected experimental animals to a standard clinical protocol of 3 doses of ampicillin i.p. and 14 days of amoxicillin added to the drinking water. NVC responses, endothelial function and cognitive performance were measured in septic and age-matched control groups within 14 days after the final antibiotic treatment. Our data demonstrate that sepsis in aging significantly impairs NVC responses measured in somatosensory cortex during whisker stimulation, significantly impairs endothelial function in isolated and pressure cannulated aorta rings in response to acetylcholine stimulation. No significant impairment of cognitive function in post-sepsis aged animals has been observed when measured using the PhenoTyper homecage based system. Our findings suggest that sepsis-associated endothelial dysfunction and impairment of NVC responses may contribute to long-term cognitive deficits in older sepsis survivors.
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Affiliation(s)
- Tamas Csipo
- Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Department of Public Health, Doctoral School of Basic and Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Benjamin R. Cassidy
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Priya Balasubramanian
- Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Douglas A. Drevets
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, United States
| | - Zoltan I. Ungvari
- Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Departments of Medical Physics and Informatics, Theoretical Medicine Doctoral School University of Szeged, Szeged, Hungary
| | - Andriy Yabluchanskiy
- Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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30
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Maldiney T, Bonnot D, Anzala N, Albac S, Labrousse D, Varon E, Amoureux L, Chapuis A, Bador J, Neuwirth C, Croisier D, Chavanet P. In vitro antimicrobial activity of daptomycin alone and in adjunction with either amoxicillin, cefotaxime or rifampicin against the main pathogens responsible for bacterial meningitis in adults. J Glob Antimicrob Resist 2021; 25:193-198. [PMID: 33774218 DOI: 10.1016/j.jgar.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES As daptomycin adjunction is currently under clinical evaluation in the multicentre phase II AddaMAP study to improve the prognosis of pneumococcal meningitis, the present work aimed at evaluating the in vitro antimicrobial activity of daptomycin-based combinations against some of the most frequent species responsible for bacterial meningitis. METHODS Clinically relevant strains of Streptococcus pneumoniae, Listeria monocytogenes, Haemophilus influenzae and Neisseria meningitidis were obtained from National Reference Centers. The antimicrobial activity of amoxicillin, cefotaxime and rifampicin, either alone or in association with daptomycin, was explored through the determination of minimum inhibitory concentration (MIC) and fractional inhibitory concentration index (FICI) as well as time-kill assay (TKA) using the broth microdilution method. RESULTS All species taken together, the adjunction of daptomycin had no deleterious impact on the antimicrobial activity of amoxicillin, cefotaxime or rifampicin in vitro. Regarding Gram-positive bacteria, FICI and TKA analysis confirmed a global improvement of growth inhibition and bactericidal activity due to the adjunction of daptomycin. The synergistic effect prevailed for L. monocytogenes as demonstrated by FICI mainly <0.5 and a dynamic TKA-based synergy rate >50%. In addition, daptomycin-based associations did not modify the activity of β-lactam antibiotics or rifampicin against Gram-negative bacteria, notably N. meningitidis. CONCLUSION These results bring comforting evidence towards the clinical potential of daptomycin adjunction in the treatment of bacterial meningitis, which supports the ongoing AddaMAP clinical trial.
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Affiliation(s)
- Thomas Maldiney
- Infectious Diseases Department, University Hospital of Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France
| | - Dorian Bonnot
- Vivexia, Résidence Richelieu, 10 Boulevard Carnot, 21000, Dijon, France
| | - Nelson Anzala
- Vivexia, Résidence Richelieu, 10 Boulevard Carnot, 21000, Dijon, France
| | - Sandrine Albac
- Vivexia, Résidence Richelieu, 10 Boulevard Carnot, 21000, Dijon, France
| | | | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Lucie Amoureux
- Department of Bacteriology, University Hospital of Dijon, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, 2 Place Saint-Jacques, Besançon, France
| | - Angélique Chapuis
- Department of Bacteriology, University Hospital of Dijon, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, 2 Place Saint-Jacques, Besançon, France
| | - Julien Bador
- Department of Bacteriology, University Hospital of Dijon, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, 2 Place Saint-Jacques, Besançon, France
| | - Catherine Neuwirth
- Department of Bacteriology, University Hospital of Dijon, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, 2 Place Saint-Jacques, Besançon, France
| | - Delphine Croisier
- Vivexia, Résidence Richelieu, 10 Boulevard Carnot, 21000, Dijon, France
| | - Pascal Chavanet
- Infectious Diseases Department, University Hospital of Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France; Vivexia, Résidence Richelieu, 10 Boulevard Carnot, 21000, Dijon, France.
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