1
|
Christo PP. "Time is brain" also for bacterial meningitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:221-223. [PMID: 31090801 DOI: 10.1590/0004-282x20190047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Paulo Pereira Christo
- Santa Casa de Belo Horizonte, Programa de Pós Graduação, Belo Horizonte MG, Brasil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte MG, Brasil
| |
Collapse
|
2
|
Gudina EK, Tesfaye M, Wieser A, Pfister HW, Klein M. Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: A prospective study. PLoS One 2018; 13:e0200067. [PMID: 30020952 PMCID: PMC6051621 DOI: 10.1371/journal.pone.0200067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mortality and neurologic sequelae associated with acute bacterial meningitis (ABM) remain high despite advances in medical care. The main aim of this study was to evaluate short-term outcome in patients treated as bacterial meningitis at a teaching hospital in Ethiopia to identify factors that could be focused on to improve outcome in this setting. METHODS A hospital based longitudinal study was conducted at Jimma University Hospital in southwest Ethiopia from March 1, 2013 to December 31, 2015. Participants of this study were patients of age 18 years and older who were treated as confirmed or possible cases of ABM. Patients were followed throughout their hospital stay for change in their clinical course and predefined end points. A multivariable analysis was done to identify factors associated with unfavorable outcomes. RESULT 90 patients admitted with diagnosis of acute bacterial meningitis were included in the study; cerebrospinal fluid was analysed for 85 (94.4%) of them. Causative bacteria were isolated in 26 (28.9%) patients only; most of these isolates (84.6%) were either Streptococcus pneumoniae or Neisseria meningitidis. Patients managed as cases of ABM at the hospital suffered from a high rate of unfavorable outcome (36.7%) and an overall mortality rate of 22.2%. Impaired level of consciousness (AOR = 0.766, 95% CI = 0.589-0.995), dexamethasone therapy (AOR = 4.676, 95% CI = 1.12-19.50) and fever persisting after two days of admission (AOR = 24.226, 95% CI = 5.24-111.96) were found to be independently associated with unfavorable outcome. CONCLUSION Outcome in patients treated for ABM at the hospital was found to be poor. Impaired mentation, treatment with adjunctive dexamethasone and persistent fever were found to be associated with poor outcome. Thus, development of clinical guidelines for treatment of ABM that suit the local context is essential to improve patient management and outcome.
Collapse
Affiliation(s)
- Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
- Centre for International Health, Ludwig-Maximilians-University, Munich, Germany
| | - Markos Tesfaye
- Centre for International Health, Ludwig-Maximilians-University, Munich, Germany
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Andreas Wieser
- Department of Bacteriology, Max von Pettenkofer Institute, Ludwig-Maximilians-University, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Ludwig-Maximilians-University, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Hans-Walter Pfister
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Klein
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
3
|
Cabrera-Gaytán D, Pérez-Pérez G, Arriaga-Nieto L, Vallejos-Parás A, Padilla-Velázquez R, Grajales-Muñiz C. Epidemiological surveillance of meningeal and encephalic syndrome in the Mexican Social Security Institute, 2012–2014. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
4
|
Gudina EK, Tesfaye M, Adane A, Lemma K, Shibiru T, Pfister HW, Klein M. Challenges of bacterial meningitis case management in low income settings: an experience from Ethiopia. Trop Med Int Health 2016; 21:870-8. [PMID: 27145202 DOI: 10.1111/tmi.12720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the current diagnostic and therapeutic strategies used in the care of patients with suspected bacterial meningitis at teaching hospitals in Ethiopia. METHODS This was a hospital-based retrospective study conducted at four teaching hospitals in different regions of Ethiopia. Participants were patients aged 14 years and older treated for suspected bacterial meningitis. Presenting complaints, diagnostic strategies used and treatments given were obtained from clinical records. RESULT A total of 425 patients were included in the study; 52.7% were men and 83.8% were younger than 50 years. Fever, headache, neck stiffness and impaired consciousness were the most common clinical presentations; 55.5% underwent lumbar puncture. Overall, only 96 (22.6%) patients had cerebrospinal fluid abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 cases. Ceftriaxone was used as the empiric treatment of choice, either alone or in combination with other antibiotics; 17.6% of patients were also given vancomycin. Adjunctive dexamethasone was given to 50.4%. CONCLUSION Most patients treated as bacterial meningitis did not receive a proper diagnostic workup. The choice of antibiotic was not tailored to the specific clinical condition of the patient. Such an approach may result in poor treatment outcomes and lead to antibiotic resistance. Management of patients with suspected bacterial meningitis should be supported by analysis of cerebrospinal fluid, and treatment should be tailored to local evidence and current evidence-based recommendations.
Collapse
Affiliation(s)
| | - Markos Tesfaye
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Aynishet Adane
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kinfe Lemma
- Department of Internal Medicine, Hawassa University, Hawassa, Ethiopia
| | - Tamiru Shibiru
- Department of Internal Medicine, Arba Minch Hospital, Arba Minch, Ethiopia
| | | | - Matthias Klein
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
5
|
Abstract
Any patient presenting to the emergency department (ED) with fever triggers consideration of the administration of an antimicrobial. Empiric antimicrobial therapy has become a cornerstone of treatment. Frequently, the decision to initiate empiric treatment needs to be made before the definitive diagnosis is known. In such cases, an organized approach is helpful. This article aims to provide a systems-based approach to prescribing antimicrobials to patients presenting to the ED with fever, while understanding the risk associated with overutilization. An understanding of the key considerations is needed to ensure that decisions are made well and appropriate treatment begins promptly.
Collapse
Affiliation(s)
- Raquel F Harrison
- Department of Emergency Medicine, New York-Presbyterian Hospital, The University Hospitals of Columbia and Cornell, New York, NY, USA
| | | |
Collapse
|
6
|
Radigan EA, Gilchrist NA, Miller MA. Management of aminoglycosides in the intensive care unit. J Intensive Care Med 2010; 25:327-42. [PMID: 20837630 DOI: 10.1177/0885066610377968] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. Aminoglycosides are bactericidal agents with potent activity against gram-negative infections and activity against gram-positive infections when added to a cell wall active antimicrobial-based regimen. These agents may be dosed multiple times a day or consolidated as high-dose, extended-interval dosing to maximize pharmacokinetic and pharmacodynamic properties to achieve possible improved efficacy with reduced toxicity. Clinical application includes the treatment of bacteremia, endocarditis, health-care and nosocomial pneumonias, intra-abdominal infections, and others. Nephrotoxicity and ototoxicity are potential risks of aminoglycoside therapy that may be minimized with serum monitoring and short courses of therapy.
Collapse
Affiliation(s)
- Elizabeth A Radigan
- Department of Pharmacy, Infectious Diseases, UMass Memorial Medical Center, Worcester, MA 01655, USA.
| | | | | |
Collapse
|
7
|
Wallis E. [Acute bacterial meningitis]. Wien Klin Wochenschr 2007; 118:109-21; quiz 122. [PMID: 17598318 DOI: 10.1007/s11812-006-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ernst Wallis
- Medizinische Abteilung mit Infektions- und Tropenmedizin, SMZ-Süd, Kaiser-Franz-Josef-Spital, Wien, Osterreich.
| |
Collapse
|
8
|
Hui ACF, Ng KC, Tong PY, Mok V, Chow KM, Wu A, Wong LKS. Bacterial meningitis in Hong Kong: 10-years’ experience. Clin Neurol Neurosurg 2005; 107:366-70. [PMID: 16023529 DOI: 10.1016/j.clineuro.2004.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 09/29/2004] [Accepted: 10/04/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We studied the etiology, clinical features and outcome of patients with bacterial meningitis from an urban Chinese city over a 10-years period. METHODS We reviewed the files of all persons aged 15-years old or above diagnosed with community-acquired bacterial meningitis from a regional hospital. The clinical findings, relevant laboratory and imaging results as well as outcome were recorded in cases with microbiological evidence of meningitis. Neurosurgical and pediatric patients were excluded. RESULTS Sixty-five patients between the ages of 15 and 86 years of age (mean 52 years) were identified of whom 18 (28%) died. The four most common causes were Mycobacteria tuberculosis (46%), Streptococcus pneumoniae (11%), Streptococcus suis (9%) and Klebsiella pneumoniae (8%). Neisseria meningitidis and Haemophilus influenzae were rare pathogens. The annual incidence of community-acquired bacterial meningitis was 1.27/100,000 adults. Delay in treatment was associated with a poorer prognosis (p<0.001, OR=38.84, CI=7.33-205.80). CONCLUSION The causative organisms found in this region of China differ from that reported from Europe and the US; tuberculous meningitis is the most common cause of bacterial meningitis.
Collapse
Affiliation(s)
- A C F Hui
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, New Terriotories, Shatin, Hong Kong SAR.
| | | | | | | | | | | | | |
Collapse
|
9
|
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267-84. [PMID: 15494903 DOI: 10.1086/425368] [Citation(s) in RCA: 1242] [Impact Index Per Article: 62.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 08/25/2004] [Indexed: 12/11/2022] Open
Affiliation(s)
- Allan R Tunkel
- Drexel University College of Medicine, Philadelphia, PA 19129, USA.
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
The therapeutic approach to acute bacterial meningitis has changed in recent years as a result of changes in in vitro susceptibility of many meningeal pathogens to previously standard antimicrobial therapy. Given the emergence of strains of Streptococcus pneumoniae that are resistant to penicillin and the cephalosporins, the combination of vancomycin plus a third-generation cephalosporin is recommended as empiric therapy for suspected or proven pneumococcal meningitis, pending results of in vitro susceptibility testing. Strains of Neisseria meningitidis with reduced susceptibility to penicillin have also been described, although most patients with these resistant strains have recovered with standard penicillin therapy. Although the third-generation cephalosporins have greatly improved outcome in patients with meningitis caused by aerobic gram-negative bacilli, many organisms in this group are now resistant to these drugs; the carbapenems and fluoroquinolones may be effective alternative agents and have been successfully used in small case series. Further surveillance of the in vitro antimicrobial susceptibility patterns of meningeal pathogens is critical for future recommendations in the treatment of bacterial meningitis.
Collapse
Affiliation(s)
- Allan R. Tunkel
- Department of Internal Medicine, MCP Hahnemann University, 3300 Henry Avenue, Philadelphia, PA 19129, USA. allan.tunkel@drexel. edu
| | | |
Collapse
|