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Community-acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort

2020; Elsevier BV; Volume: 26; Issue: 9 Linguagem: Inglês

10.1016/j.cmi.2019.12.020

1469-0691

Sarah Tubiana, Emmanuelle Varon, Charlotte Biron, M.-C. Ploy, Bruno Mourvillier, Muhamed‐Kheir Taha, Matthieu Revest, Claire Poyart, Guillaume Martin‐Blondel, Marc Lecuit, Éric Cua, Blandine Pasquet, Marie Préau, Bruno Hoen, Xavier Duval, Xavier Duval, Bruno Hoen, Bruno Mourvillier, Marie-Cécile Ploy, Sarah Tubiana, Emmanuelle Varon, François Caron, Pierre‐Édouard Bollaert, Olivier Gaillot, Muhamed‐Kheir Taha, Claire Poyart, Stéphane Bonacorsi, François Vandenesch, Emmanuelle Cambau, Marc Lecuit, Alain Gravet, Bruno Frachet, T. de Broucker, D Lévy-Brühl, F. Raffi, Nadia Anguel, Laurent Argaud, S. Arista, Laurence Armand-Lefevre, Stéphanie Balavoine, Régine Baraduc, Guilène Barnaud, Guillaume Béraud, Louis Bernard, Georges Bernars, Dominique Bertei, Emilie Bessède, Typhaine Billard Pomares, Charlotte Biron, Stéphane Bland, J. Boileau, Patrice Boubeau, Sandra Bourdon, Aurore Bousquet, Sophie Boyer, A. Bozorg–Grayeli, Laurent Bret, Cédric Bretonnière, François Bricaire, Elsa Brocas, Michel Brun, J. Buret, Christophe Burucoa, Jean Cabalion, Mathieu Cabon, Emmanuelle Cambau, G. Camuset, Christophe Canevet, François Caron, Anne Carricajo, Bernard Castan, Éric Caumes, Charles Cazanave, Amélie Chabrol, T. Challan-Belval, Vanessa Chanteperdrix-Marillier, C. Chaplain, Caroline Charlier-Woerther, H. Chaussade, Catherine Chirouze, Bernard Clair, Julien Colot, Jean‐Marie Conil, Hugues Cordel, Philippe Cormier, Joël Cousson, Pierrick Cronier, Éric Cua, Anne Dao-Dubremetz, S. Dargère, Nicolas Degand, S. Dekeyser, Déborah Delaune, É. Denes, Pierre‐François Dequin, Diane Descamps, Élodie Descloux, Jean-Luc Desmaretz, Jean‐Luc Diehl, Jérôme Dimet, Aurélien Dinh, Xavier Duval, L. Escaut, Claude Fabe, F. Faibis, C. Flateau, Nathalie Fonsale, E. Forestier, Nicolas Fortineau, Amandine Gagneux‐Brunon, Garandeau, Magali Garcia, Denis Garot, Stéphane Gaudry, François Goehringer, Alain Gravet, Valérie Gregoire-Faucher, Marine Grosset, C. Gubavu, I. Gueït, D. Guélon, Thomas Guimard, Jérôme Guinard, Tahar Hadou, Jean-Pierre Helene, Sandrine Henard, Benoît Henry, Anne-Cécile Hochart, Bruno Hoen, Gabriela Illes, S. Jaffuel, Irène Jarrin, Françoise Jauréguy, Cédric Joseph, Marie-Emmanuelle Juvin, Samer Kayal, F. Lacassin, I. Lamaury, Philippe Lanotte, E. Laurens, H. Laurichesse, Cécile Le Brun, Vincent Le Moing, Paul Le Turnier, Hervé Lecuyer, Sylvie Ledru, Céline Legrix, Adrien Lemaignen, Chantal Lemblé, Ludovic Lemée, O. Lesens, Marion Levast, Claire Lhommet, S. Males, Edith Malpote, Guillaume Martin‐Blondel, Matthieu Marx, Raphaël Masson, Olivier Matray, Aurore Mbadi, F. Méchaï, Guillaume Mellon, Audrey Mérens, M.C. Meyohas, Adrien Michon, Joy Mootien Yoganaden, David Morquin, Stéphane Mouly, Natacha Mrozek, Sophie Nguyen, Yohan N’Guyen, Maja Ogielska, E. Oziol, Bernard Page, S. Patrat-Delon, Isabelle Patry, A. Péchinot, Stéphane Picot, Pierrejean, Lionel Piroth, Claire Plassart, Patrice Plessis, Marie-Cécile Ploy, L. Portel, P. Poubeau, Marie Poupard, Claire Poyart, Thiérry Prazuck, Luc Quaesaet, François Raffi, Adriatsiferana Ramanantsoa, C. Rapp, Laurent Raskine, Josette Raymond, Matthieu Revest, Agnès Riché, Stéphanie Robaday-Voisin, Frédéric Robin, J.‐P. Romaszko, Florence Rousseau, Anne‐Laure Roux, Cécile Royer, Matthieu Saada, Dominique Salmon, Carlo Saroufim, Jean‐Luc Schmit, Manuela Sébire, Christine Segonds, Valérie Sivadon‐Tardy, Nathalie Soismier, Solen Kernéis, Olivia Son, Simon Sunder, Florence Suy, Didier Tandé, Jacques Tankovic, Nadia Valin, Nicolas Van Grunderbeeck, François Vandenesch, Emmanuelle Varon, Renaud Verdon, M. Vergnaud, Véronique Vernet-Garnier, M. Vidal, Virginie Vitrat, Daniel Vittecoq, Fanny Vuotto, Coordination and statistical analyses, Isabelle Gorenne, Cédric Laouénan, Estelle Marcault, France Mentré, Blandine Pasquet, Carine Roy, Sarah Tubiana,

Infective Endocarditis Diagnosis and Management

ObjectivesTo identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM).MethodsIn 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.ResultsAmong 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; 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).ConclusionsThe 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.ClinicalTrialGov identification number: NCT01730690.