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Update on community-acquired bacterial meningitis: guidance and challenges

2017; Elsevier BV; Volume: 23; Issue: 9 Linguagem: Inglês

10.1016/j.cmi.2017.04.019

1469-0691

Cornelis N. van Ettekoven, Diederik van de Beek, Matthijs C. Brouwer,

Streptococcal Infections and Treatments

BackgroundThe existing heterogeneity in diagnostic work-up and treatment strategies in bacterial meningitis was the incentive to develop a European evidence-based guideline, which was published in 2016 by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Infections of the Brain (ESGIB).AimsTo summarize salient features of the guideline, identify recent developments and challenges currently faced.SourcesThe ESCMID guideline, ongoing trial registries.ContentEpidemiology, clinical symptoms, diagnostic work-up and therapy strategies of acute bacterial meningitis.ImplicationsThe incidence of bacterial meningitis has decreased following pneumococcal and meningococcal conjugate vaccine introduction. In the diagnosis of bacterial meningitis the clinical characteristics and laboratory parameters are of limited diagnostic accuracy and therefore cerebrospinal fluid analysis remains the principal contributor to the final diagnosis. The ESCMID guideline advises to start empiric treatment within one hour of arrival in all suspected meningitis cases, and choice of antibiotics needs to be differentiated according to the patient's age, risk factors, and local resistance rates of pneumococci. Dexamethasone is the only proven adjunctive treatment and should be started together with the antibiotics. The follow-up of surviving patients should include evaluation for hearing loss and pneumococcal vaccination to prevent recurrences. Future perspectives include further development and implementation of vaccines, and new treatments aimed at further reducing the inflammatory response. Studies on implementation of the new guideline should determine adherence and evaluate whether improved prognosis can be achieved by following protocolled management strategies.