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Thy M, Dupuis C, Mageau A, Mourvillier B, Bouadma L, Ruckly S, Perozziello A, Strukov A, Van-Gysel D, de Montmollin E, Sonneville R, Timsit JF. Impact of direct ICU admission of pneumococcal meningitis in France: a retrospective analysis of a French medico-administrative (PMSI) database. Ann Intensive Care 2024; 14:15. [PMID: 38279066 PMCID: PMC10817881 DOI: 10.1186/s13613-023-01239-1] [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: 10/01/2023] [Accepted: 12/29/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Current guidelines for adult patients with pneumococcal meningitis (PM) recommend initial management in intermediate or intensive care units (ICU), but evidence to support these recommendations is limited. We aimed to describe ICU admission practices of patients with PM. METHODS We conducted a retrospective analysis of the French medico administrative database of consecutive adult patients with PM and sepsis criteria hospitalized between 2011 and 2020. We defined two groups, "Direct ICU" corresponding to a direct ICU admission and "Delayed ICU" corresponding to a secondary ICU admission. RESULTS We identified 4052 patients hospitalized for a first episode of PM, including 2006 "Direct ICU" patients (50%) and 2046 "delayed ICU" patients (50%). The patients were mainly males [n = 2260 (56%)] with median age of 61 years [IQR 50-71] and a median Charlson index of 1 [0-3]. Among them, median SAPS II on admission was 46 [33-62], 2173 (54%) had a neurological failure on admission with 2133 (53%) in coma, 654 (16%) with brainstem failure, 488 (12%) with seizures and 779 (19%) with focal signs without coma. PM was frequently associated with pneumonia [n = 1411 (35%)], and less frequently with endocarditis [n = 317 (8%)]. The median ICU length of stay and hospital length of stay were 6 days [2-14] and 21 days [13-38], respectively. In-hospital mortality was 27% (n = 1100) and 640 (16%) patients were secondarily transferred to rehabilitation care unit. Direct ICU group was significantly more severe but after adjustment for age, sex, comorbidities, organ failures on admission and admission from home, direct ICU admission was significantly associated with a lower mortality (Odds ratio 0.67 [0.56-0.80], p < 0.01). This corresponded to one death avoided for 11 PM directly admitted in ICU. CONCLUSIONS Among patients with PM and sepsis, direct ICU admission was associated with lower mortality rates when compared to delayed admission.
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Affiliation(s)
- Michael Thy
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France.
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France.
| | - Claire Dupuis
- Department of Intensive Care Medicine, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Arthur Mageau
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Bruno Mourvillier
- Medical Intensive Care Unit, Robert Debré University Hospital, Reims, France
| | - Lila Bouadma
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Stéphane Ruckly
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Anne Perozziello
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Andrey Strukov
- Department of Medical Information, Bichat Claude Bernard University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Damien Van-Gysel
- Department of Medical Information, Bichat Claude Bernard University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Etienne de Montmollin
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Romain Sonneville
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
| | - Jean-François Timsit
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France
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