Community-acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort
S Tubiana, E Varon, C Biron, M-C Ploy, B Mourvillier, M-K Taha, M Revest, C Poyart, G Martin-Blondel, M Lecuit, E Cua, B Pasquet, M Preau, B Hoen, X Duval, COMBAT study group, Xavier Duval, Bruno Hoen, Bruno Mourvillier, Marie-Cécile Ploy, Sarah Tubiana, Emmanuelle Varon, François Caron, Pierre-Edouard Bollaert, Olivier Gaillot, Muhamed-Kheir Taha, Claire Poyart, Stephane Bonacorsi, François Vandenesch, Emmanuelle Cambau, Marc Lecuit, Alain Gravet, Bruno Frachet, Thomas De Broucker, Daniel Levy Bruhl, François Raffi, Nadia Anguel, Laurent Argaud, Sophie Arista, Laurence Armand-Lefevre, Stéphanie Balavoine, Régine Baraduc, Guilène Barnaud, Guillaume Beraud, Louis Bernard, Georges Bernars, Dominique Bertei, Emilie Bessede, Typhaine Billard Pomares, Charlotte Biron, Stéphane Bland, Julien Boileau, Patrice Boubeau, Sandra Bourdon, Aurore Bousquet, Sophie Boyer, Alexis Bozorg-Grayeli, Laurent Bret, Cédric Bretonniere, François Bricaire, Elsa Brocas, Michel Brun, Jennifer Buret, Christophe Burucoa, Jean Cabalion, Mathieu Cabon, Emmanuelle Cambau, Guillaume Camuset, Christophe Canevet, François Caron, Anne Carricajo, Bernard Castan, Eric Caumes, Charles Cazanave, Amélie Chabrol, Thibaut Challan-Belval, Vanessa Chanteperdrix-Marillier, Chantal Chaplain, Caroline Charlier-Woerther, Hélène Chaussade, Catherine Chirouze, Bernard Clair, Julien Colot, Jean-Marie Conil, Hugues Cordel, Philippe Cormier, Joël Cousson, Pierrick Cronier, Eric Cua, Anne Dao-Dubremetz, Sylvie Dargere, Nicolas Degand, Sophie Dekeyser, Deborah Delaune, Eric Denes, Pierre-Francois Dequin, Diane Descamps, Elodie Descloux, Jean-Luc Desmaretz, Jean-Luc Diehl, Jérôme Dimet, Aurélien Dinh, Xavier Duval, Lelia Escaut, Claude Fabe, Frédéric Faibis, Clara Flateau, Nathalie Fonsale, Emmanuel Forestier, Nicolas Fortineau, Amandine Gagneux-Brunon, Garandeau, Magali Garcia, Denis Garot, Stéphane Gaudry, François Goehringer, Alain Gravet, Valérie Gregoire-Faucher, Marine Grosset, Camélia Gubavu, Isabelle Gueit, Dominique Guelon, Thomas Guimard, Jérôme Guinard, Tahar Hadou, Jean-Pierre Helene, Sandrine Henard, Benoit Henry, Anne-Cécile Hochart, Bruno Hoen, Gabriela Illes, Sylvain Jaffuel, Irène Jarrin, Françoise Jaureguy, Cédric Joseph, Marie-Emmanuelle Juvin, Samer Kayal, Flore Lacassin, Isabelle Lamaury, Philippe Lanotte, Etienne Laurens, Henri Laurichesse, Cécile Le Brun, Vincent Le Moing, Paul Le Turnier, Hervé Lecuyer, Sylvie Ledru, Céline Legrix, Adrien Lemaignen, Chantal Lemble, Ludovic Lemee, Olivier Lesens, Marion Levast, Claire Lhommet, Silvija Males, Edith Malpote, Guillaume Martin-Blondel, Matthieu Marx, Raphael Masson, Olivier Matray, Aurore Mbadi, Frédéric Mechai, Guillaume Mellon, Audrey Merens, Marie Caroline Meyohas, Adrien Michon, Joy Mootien Yoganaden, David Morquin, Stéphane Mouly, Natacha Mrozek, Sophie Nguyen, Yohan Nguyen, Maja Ogielska, Eric Oziol, Bernard Page, Solène Patrat-Delon, Isabelle Patry, André Pechinot, Sandrine Picot, Pierrejean, Lionel Piroth, Claire Plassart, Patrice Plessis, Marie-Cécile Ploy, Laurent Portel, Patrice Poubeau, Marie Poupard, Claire Poyart, Thierry Prazuck, Luc Quaesaet, François Raffi, Adriatsiferana Ramanantsoa, Christophe Rapp, Laurent Raskine, Josette Raymond, Matthieu Revest, Agnès Riche, Stéphanie Robaday-Voisin, Frédéric Robin, Jean-Pierre Romaszko, Florence Rousseau, Anne-Laure Roux, Cecile Royer, Matthieu Saada, Dominique Salmon, Carlo Saroufim, Jean-Luc Schmit, Manuela Sebire, Christine Segonds, Valérie Sivadon-Tardy, Nathalie Soismier, Solen Kerneis, Olivia Son, Simon Sunder, Florence Suy, Didier Tande, Jacques Tankovic, Nadia Valin, Nicolas Van Grunderbeeck, François Vandenesch, Emmanuelle Varon, Renaud Verdon, Michel Vergnaud, Véronique Vernet-Garnier, Magali Vidal, Virginie Vitrat, Daniel Vittecoq, Fanny Vuotto, Coordination And Statistical Analyses, Isabelle Gorenne, Cédric Laouenan, Estelle Marcault, France Mentre, Blandine Pasquet, Carine Roy, Sarah Tubiana, S Tubiana, E Varon, C Biron, M-C Ploy, B Mourvillier, M-K Taha, M Revest, C Poyart, G Martin-Blondel, M Lecuit, E Cua, B Pasquet, M Preau, B Hoen, X Duval, COMBAT study group, Xavier Duval, Bruno Hoen, Bruno Mourvillier, Marie-Cécile Ploy, Sarah Tubiana, Emmanuelle Varon, François Caron, Pierre-Edouard Bollaert, Olivier Gaillot, Muhamed-Kheir Taha, Claire Poyart, Stephane Bonacorsi, François Vandenesch, Emmanuelle Cambau, Marc Lecuit, Alain Gravet, Bruno Frachet, Thomas De Broucker, Daniel Levy Bruhl, François Raffi, Nadia Anguel, Laurent Argaud, Sophie Arista, Laurence Armand-Lefevre, Stéphanie Balavoine, Régine Baraduc, Guilène Barnaud, Guillaume Beraud, Louis Bernard, Georges Bernars, Dominique Bertei, Emilie Bessede, Typhaine Billard Pomares, Charlotte Biron, Stéphane Bland, Julien Boileau, Patrice Boubeau, Sandra Bourdon, Aurore Bousquet, Sophie Boyer, Alexis Bozorg-Grayeli, Laurent Bret, Cédric Bretonniere, François Bricaire, Elsa Brocas, Michel Brun, Jennifer Buret, Christophe Burucoa, Jean Cabalion, Mathieu Cabon, Emmanuelle Cambau, Guillaume Camuset, Christophe Canevet, François Caron, Anne Carricajo, Bernard Castan, Eric Caumes, Charles Cazanave, Amélie Chabrol, Thibaut Challan-Belval, Vanessa Chanteperdrix-Marillier, Chantal Chaplain, Caroline Charlier-Woerther, Hélène Chaussade, Catherine Chirouze, Bernard Clair, Julien Colot, Jean-Marie Conil, Hugues Cordel, Philippe Cormier, Joël Cousson, Pierrick Cronier, Eric Cua, Anne Dao-Dubremetz, Sylvie Dargere, Nicolas Degand, Sophie Dekeyser, Deborah Delaune, Eric Denes, Pierre-Francois Dequin, Diane Descamps, Elodie Descloux, Jean-Luc Desmaretz, Jean-Luc Diehl, Jérôme Dimet, Aurélien Dinh, Xavier Duval, Lelia Escaut, Claude Fabe, Frédéric Faibis, Clara Flateau, Nathalie Fonsale, Emmanuel Forestier, Nicolas Fortineau, Amandine Gagneux-Brunon, Garandeau, Magali Garcia, Denis Garot, Stéphane Gaudry, François Goehringer, Alain Gravet, Valérie Gregoire-Faucher, Marine Grosset, Camélia Gubavu, Isabelle Gueit, Dominique Guelon, Thomas Guimard, Jérôme Guinard, Tahar Hadou, Jean-Pierre Helene, Sandrine Henard, Benoit Henry, Anne-Cécile Hochart, Bruno Hoen, Gabriela Illes, Sylvain Jaffuel, Irène Jarrin, Françoise Jaureguy, Cédric Joseph, Marie-Emmanuelle Juvin, Samer Kayal, Flore Lacassin, Isabelle Lamaury, Philippe Lanotte, Etienne Laurens, Henri Laurichesse, Cécile Le Brun, Vincent Le Moing, Paul Le Turnier, Hervé Lecuyer, Sylvie Ledru, Céline Legrix, Adrien Lemaignen, Chantal Lemble, Ludovic Lemee, Olivier Lesens, Marion Levast, Claire Lhommet, Silvija Males, Edith Malpote, Guillaume Martin-Blondel, Matthieu Marx, Raphael Masson, Olivier Matray, Aurore Mbadi, Frédéric Mechai, Guillaume Mellon, Audrey Merens, Marie Caroline Meyohas, Adrien Michon, Joy Mootien Yoganaden, David Morquin, Stéphane Mouly, Natacha Mrozek, Sophie Nguyen, Yohan Nguyen, Maja Ogielska, Eric Oziol, Bernard Page, Solène Patrat-Delon, Isabelle Patry, André Pechinot, Sandrine Picot, Pierrejean, Lionel Piroth, Claire Plassart, Patrice Plessis, Marie-Cécile Ploy, Laurent Portel, Patrice Poubeau, Marie Poupard, Claire Poyart, Thierry Prazuck, Luc Quaesaet, François Raffi, Adriatsiferana Ramanantsoa, Christophe Rapp, Laurent Raskine, Josette Raymond, Matthieu Revest, Agnès Riche, Stéphanie Robaday-Voisin, Frédéric Robin, Jean-Pierre Romaszko, Florence Rousseau, Anne-Laure Roux, Cecile Royer, Matthieu Saada, Dominique Salmon, Carlo Saroufim, Jean-Luc Schmit, Manuela Sebire, Christine Segonds, Valérie Sivadon-Tardy, Nathalie Soismier, Solen Kerneis, Olivia Son, Simon Sunder, Florence Suy, Didier Tande, Jacques Tankovic, Nadia Valin, Nicolas Van Grunderbeeck, François Vandenesch, Emmanuelle Varon, Renaud Verdon, Michel Vergnaud, Véronique Vernet-Garnier, Magali Vidal, Virginie Vitrat, Daniel Vittecoq, Fanny Vuotto, Coordination And Statistical Analyses, Isabelle Gorenne, Cédric Laouenan, Estelle Marcault, France Mentre, Blandine Pasquet, Carine Roy, Sarah Tubiana
Abstract
Objectives: To identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM).
Methods: In a prospective multicentre cohort study (COMBAT; February 2013 to July 2015), all consecutive cases of CABM in the 69 participating centres in France were enrolled and followed up for 12 months. Factors associated with unfavourable outcome were identified by logistic regression and long-term disability was analysed.
Results: Among the 533 individuals enrolled, (Streptococcus pneumoniae 53.8% (280/520 isolates identified), Neisseria meningitidis 21.3% (111/520), others 24.9% (129/520)), case fatality rate was 16.9% (90/533) and unfavourable outcome occurred in 45.0% (225/500). Factors independently associated with unfavourable outcome were: age >70 years (adjusted odds ratio (aOR) 4.64; 95% CI 1.93-11.15), male gender (aOR 2.11; 95% CI 1.25-3.57), chronic renal failure (aOR 6.65; 95% CI 1.57-28.12), purpura fulminans (aOR 4.37; 95% CI 1.38-13.81), localized neurological signs (aOR 3.72; 95% CI 2.29-6.05), disseminated intravascular coagulation (aOR 3.19; 95% CI 1.16-8.79), cerebrospinal fluid (CSF) white-cell count <1500 cells/μL (aOR 2.40; 95% CI 1.42-4.03), CSF glucose concentration (0.1-2.5 g/L: aOR 1.92; 95% CI 1.01-3.67; <0.1 g/L: aOR 2.24; 95% CI 1.01-4.97), elevated CSF protein concentration (aOR 1.09; 95% CI 1.03-1.17), time interval between hospitalization and lumbar puncture >1 day (aOR 2.94; 95% CI 1.32-6.54), and S. pneumoniae meningitis (aOR 4.99; 95% CI 1.98-12.56), or meningitis other than N. meningitidis (aOR 4.54; 95% CI 1.68-12.27). At 12 months, 26.7% (74/277) had hearing loss, 32.8% (87/265) depressive symptoms, 31.0% (86/277) persistent headache, and 53.4% had a physical health-related quality of life (142/266) <25th centile of the distribution of the score in the general French population (p < 0.0001).
Conclusions: The burden of CABM (death, disability, depression, impaired quality of life and hearing loss) is high. Identification of cases from the first symptoms may improve prognosis.
Clinicaltrial: Gov identification number: NCT01730690.
Keywords: Bacterial; Community-acquired; Determinants; Long-term outcome; Prognosis.
Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Source: PubMed