Pearls from Dr. Rachel Gordon
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
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Posted 03/20/17 09:06:59 AM by Matthew Cummings
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