• Epidemiology of bacterial meningitis in 21st century (Lancet ID 2016)
  • Adult (aged >16) cases identified in a Dutch national reference laboratory that received clinical specimens from approximately 85% of all bacterial meningitis cases in the country
  • 1412 episodes in the study period; 72% S.pneumoniae. 
    • Incidence: 1.72 cases/100,000 adults annually in 2007–2008 to 0.94/100,000 per year in 2013–2014
    • 17% of patients died at hospital discharge
    • Mortality rates were pathogen-dependent: 18% pneumococcal, 3% meningococcal, 35% for ListeriaCABM, respectively
  
  

  Posted 03/20/17 09:00:19 AM by Matthew Cummings

• Cochrane Review: Steroids for Bacterial Meningitis (2015)
  • Dexamethasone: no significant reduction in death rate overall (17.8% versus 19.9%). 
    • Significantly lower rates of severe hearing loss (6.0% versus 9.3%), any hearing loss (13.8% versus 19.0%) and neurological sequelae (17.9% versus 21.6%).
  • Stratification by pathogen: S. Pneumoniae --> lower death rate (29.9% versus 36.0%)
    • No effect on mortality seen in patients with H. influenzae and N. meningitidis
  
  

  Posted 03/20/17 09:02:26 AM by Matthew Cummings

• Systematic Review/Meta-analysis of CSF Lactate to Distinguish Bacterial vs. Viral Meningitis
  • 25 studies evaluated: 16 countries, 783 bacterial and 909 aseptic meningitis patients
    • Sensitivity for bacterial meningitis (if >6mmol/L) --> 96%, AUC 0.98
  • Mechanism of elevation unclear: anaerobic glycolysis of brain tissue due to decreased cerebral blood flow and O2 uptake
    • CSF lactate concentration independent of serum lactate
  
  

  Posted 03/20/17 09:03:19 AM by Matthew Cummings

• For further reading...

  Cochrane Review of Steroids in Bacterial Meningitis (2015)
  Community-acquired bacterial meningitis in adults in the Netherlands, 2006–14: a prospective cohort study (Lancet ID 2016)
  Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis (Crit Care 2010)
  
  

  Posted 03/20/17 09:06:59 AM by Matthew Cummings

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