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Long-term neuro-functional disability in adult patients with community-acquired bacterial meningitis

Abstract

Purpose

To investigate the prevalence of neuro-functional disability and its determinants 12 months after community-acquired bacterial meningitis (CABM) in adult patients.

Methods

In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM were enrolled and followed up for 12 months. Neuro-functional disability at 12 months was evaluated using a combination of the Glasgow Outcome Scale (functional disability), and the modified Rankin Disability Scale (physical disability). Factors associated with neuro-functional disability were identified by multivariate logistic regression.

Results

Among 281 patients, 84 (29.9%) patients exhibited neuro-functional disability at 12 months: 79 (28.1%) with functional disability and 51 (18.1%) with physical disability. Overall, 6 patients (2.1%) died during the follow-up. The most common pathogen identified was Streptococcus pneumoniae (131/272, 48.2%); 77/268 patients (28.7%) had a physical disability at hospital discharge. Factors independently associated with 12-month neuro-functional disability were a pneumococcal meningitis (adjusted OR = 2.8; 95% confidence interval (CI) = [1.3; 6.7]), the presence of a physical disability at hospital discharge (aOR = 2.3; 95%CI = [1.2; 4.4]) and the presence of behavioral disorders at hospital-discharge (aOR = 5.9; 95%CI = [1.6; 28.4]). Dexamethasone use was not significantly associated with neuro-functional disability (OR = 0.2; 95%CI = [< 0.1;1.3]).

Conclusion

Neuro-functional disability is frequently reported 12 months after CABM. Detailed neurological examination at discharge is needed to improve the follow-up.

Trial registration

NCT01730690.

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Availability of data and material

Data will be made upon reasonable request to the corresponding author.

Code availability

Not applicable.

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Acknowledgements

Combat study group; Principal investigator: X. Duval. Steering Committee: B. Hoen, B. Mourvillier, E. Varon, S. Tubiana, M. C. Ploy. Scientific committee: steering committee and the following members F. Caron, Pe. Bollaert, O. Gaillot, Mk. Taha, C. Poyart, S Bonacorsi, F. Vandenesch, E. Cambau, M Lecuit, A. Gravet, B. Frachet, T. Dde Broucker, D. Levy Bruhl, F. Raffi. Clinical centers: B. Abraham, F. Ader, E. Ancel, N. Anguel, L. Argaud, S. Arista, L. Armand-Lefevre, MN. Bachelier, S. Balavoine, R. Baraduc, G. Barnaud, G. Beraud, D. Bertei, E. Bessede, T. Billard Pomares, C. Biron, G. Blanchard-Marche, S. Bland, J. Boileau, C. Bornstain, S. Bourdon, A. Bousquet, S. Boyer, A. Bozorg-Grayeli, L. Bret, F. Bricaire, E. Brocas, M. Brun, J. Buret, C. Burucoa, E. Cambau, G. Camuset, C. Canevet, F. Caron, A. Carricajo, I. Casin, D. Cassignard, B. Castan, C. Cazanave, T. Challan-Belval, C. Chandesris, V. Chanteperdrix-Marillier, C. Chaplain, C. Charlier-Woerther, H. Chaussade, C. Chirouze, M. Chomarat, YE Claessens, B. Clair, D. Combaux, JM Conil, H. Cordel, P. Cormier, J. Cousson, P. Cronier, E. Cua, V. Daneluzzi, A. Dao Dubremetz, A. Defarcy, N. Degand, S. Dekeyser, D. Delaune, E. Denes, D. Descamps, Jl Desmaretz, E. Devaud, MC. Di Palma, S. Diamantis, JL. Diehl, J. Dimet, A. Dinh, X. Duval, E. Descloux, J. Colot, A. Emirian, O. Epaulard, L. Escaut, C. Fabe, T. Ferry, H. Fiette, C. Flateau, N. Fonsale, E. Forestier, N. Fortineau, T. Fraisse, F. Faibis, M. Froidure, S. Gabriel-Solean, A. Gagneux-Brunon, Garandeau, M. Garcia, V. Garnier, S. Gaudry, R. Ghozzi, A. Gravet, V. Gregoire-Faucher, M. Grosset, I. Gueit, D. Guelon, C. Guillet Caruba, T. Guimard, Y. Guimard, J. Guinard, T Hadou, JP. Helene, S. Henard, B. Henry, R. Hernu, AC. Hochart, B. Hoen, N. Idri, G. Illes, X. Jacob, S. Jaffuel, D. Jan, I. Jarrin, F. Jaureguy, C. Joseph, ME. Juvin, S. Kayal, F. Lacassin, M. Lafaurie, B. Lalanne, I. Lamaury, P. Lanotte, MF. Lartigue, Y. Latorre, P. Laudat, E. Laurens, H. Laurichesse, C. Le Brun, V. Le Moing, P. Le Turnier, H. Lecuyer, S. Ledru, L. Legout, C. Legrix, A. Lemaignen, C. Lemble, L. Lemee, S. Leotard, O. Lesens, P. Lesprit, M. Levast, F. Louis, L. Quaesaet, N. Luizy, S. Males, E. Malpote, G. Martin-Blondel, V. Martinez, R. Masson, O. Matray, A. Mbadi, F. Mechai, A. Merens, MC. Meyohas, G. Michel, A. Michon, J. Mootien Yoganaden, D. Morquin, S. Mouly, N. Mrozek, S. Nguyen, Y. Nguyen, A. Odinotte, M. Ogielska, E. Oziol, B. Page, E. Parisi-Duchene, T. Pasdeloup, S. Patrat-Delon, I. Patry, A. Pechinot, I. Pelloux, S. Picot, J. Pierre, L. Piroth, C. Plassart, P. Plessis, C. Ploton, MC. Ploy, L. Portel, M. Poupard, C. Poyart, T. Prazuck, F. Raffi, A. Ramanantsoa, C. Rapp, L. Raskine, J. Raymond, M. Revest, A. Riche, S. Robaday-Voisin, F. Robin, F. Roblot, JP. Romaszko, F. Rousseau, AL. Roux, C. Royer, M. Saada, D. Salmon, C. Saroufim, JL. Schmit, M. Sebire, C. Segonds, F. Sifaoui, V. Sivadon-Tardy, N. Soismier, K. Solen, A. Sommabere, O. Son, JP. Stahl, R. Steux, S. Sunder, F. Suy, D. Tande, J. Tankovic, S. Tigaud, B. Tourrand, N. Valin, N. Van Grunderbeeck, F. Vandenesch, E. Varon, R. Vatan, C. Venot, M. Vergnaud, Vernet, M. Vidal, V. Vitrat, D. Vittecoq, F. Vuotto, A. Chabrol, J. Cabalion. Coordination and statistical analyses (Clinical trial unit, Hôpitaux Universitaires Paris Nord Val de Seine, AP-HP, Paris): GORENNE Isabelle, LAOUENAN Cédric, MARCAULT Estelle, MENTRE France, PASQUET Blandine, ROY Carine, TUBIANA Sarah F. Mentré, C. Laouenan, I. Gorenne, E. Marcault, P. Manchon, B. Pasquet, C. Roy. Scientific partnership: SPLIF, CMIT, SRLF, SFM, REIVAC, SFORL, APNET. Partners: ORP (MC PLOY), GPIP/ACTIV (Corinne Levy). Fundings: French ministry of health, Inserm, SPILF, Pfizer pharmaceutical company. Sponsor: DRCI APHP. ClinicalTrial.gov identification number: NCT01730690.

X. Duval, B. Hoen, B. Mourvillier, E. Varon, S. Tubiana, M. C. Ploy, F. Caron, Pe. Bollaert, O. Gaillot, Mk. Taha, C. Poyart, S Bonacorsi, F. Vandenesch, E. Cambau, M. Lecuit, A. Gravet, B. Frachet, T. De Broucker, D. Levy Bruhl, F. Raffi, B. Abraham, F. Ader, E. Ancel, N. Anguel, L. Argaud, S. Arista, L. Armand-Lefevre, M. N. Bachelier, S. Balavoine, R. Baraduc, G. Barnaud, G. Beraud, D. Bertei, E. Bessede, T. Billard Pomares, C. Biron, G. Blanchard-Marche, S. Bland, J. Boileau, C. Bornstain, S. Bourdon, A. Bousquet, S. Boyer, A. Bozorg-Grayeli, L. Bret, F. Bricaire, E. Brocas, M. Brun, J. Buret, C. Burucoa, E. Cambau, G. Camuset, C. Canevet, F. Caron, A. Carricajo, I. Casin, D. Cassignard, B. Castan, C. Cazanave, T. Challan-Belval, C. Chandesris, V. Chanteperdrix-Marillier, C. Chaplain, C. Charlier-Woerther, H. Chaussade, C. Chirouze, M. Chomarat, Y. E. Claessens, B. Clair, D. Combaux, J. M. Conil, H. Cordel, P. Cormier, J. Cousson, P. Cronier, E. Cua, V. Daneluzzi, A. Dao Dubremetz, A. Defarcy, N. Degand, S. Dekeyser, D. Delaune, E. Denes, D. Descamps, Jl. Desmaretz, E. Devaud, M. C. Di Palma, S. Diamantis, J. L. Diehl, J. Dimet, A. Dinh, X. Duval, E. Descloux, J. Colot, A. Emirian, O. Epaulard, L. Escaut, C. Fabe, T. Ferry, H. Fiette, C. Flateau, N. Fonsale, E. Forestier, N. Fortineau, T. Fraisse, F. Faibis, M. Froidure, S. Gabriel-Solean, A. Gagneux-Brunon, Garandeau, M. Garcia, V. Garnier, S. Gaudry, R. Ghozzi, A. Gravet, V. Gregoire-Faucher, M. Grosset, I. Gueit, D. Guelon, C. Guillet Caruba, T. Guimard, Y. Guimard, J. Guinard, T Hadou, J. P. Helene, S. Henard, B. Henry, R. Hernu, A. C. Hochart, B. Hoen, N. Idri, G. Illes, X. Jacob, S. Jaffuel, D. Jan, I. Jarrin, F. Jaureguy, C. Joseph, M. E. Juvin, S. Kayal, F. Lacassin, M. Lafaurie, B. Lalanne, I. Lamaury, P. Lanotte, M. F. Lartigue, Y. Latorre, P. Laudat, E. Laurens, H. Laurichesse, C. Le Brun, V. Le Moing, P. Le Turnier, H. Lecuyer, S. Ledru, L. Legout, C. Legrix, A. Lemaignen, C. Lemble, L. Lemee, S. Leotard, O. Lesens, P. Lesprit, M. Levast, F. Louis, L. Quaesaet, N. Luizy, S. Males, E. Malpote, G. Martin-Blondel, V. Martinez, R. Masson, O. Matray, A. Mbadi, F. Mechai, A. Merens, M. C. Meyohas, G. Michel, A. Michon, J. Mootien Yoganaden, D. Morquin, S. Mouly, N. Mrozek, S. Nguyen, Y. Nguyen, A. Odinotte, M. Ogielska, E. Oziol, B. Page, E. Parisi-Duchene, T. Pasdeloup, S. Patrat-Delon, I. Patry, A. Pechinot, I. Pelloux, S. Picot, J. Pierre, L. Piroth, C. Plassart, P. Plessis, C. Ploton, M. C. Ploy, L. Portel, M. Poupard, C. Poyart, T. Prazuck, F. Raffi, A. Ramanantsoa, C. Rapp, L. Raskine, J. Raymond, M. Revest, A. Riche, S. Robaday-Voisin, F. Robin, F. Roblot, J. P. Romaszko, F. Rousseau, A. L. Roux, C. Royer, M. Saada, D. Salmon, C. Saroufim, J. L. Schmit, M. Sebire, C. Segonds, F. Sifaoui, V. Sivadon-Tardy, N. Soismier, K. Solen, A. Sommabere, O. Son, JP. Stahl, R. Steux, S. Sunder, F. Suy, D. Tande, J. Tankovic, S. Tigaud, B. Tourrand, N. Valin, N. Van Grunderbeeck, F. Vandenesch, E. Varon, R. Vatan, C. Venot, M. Vergnaud, Vernet, M. Vidal, V. Vitrat, D. Vittecoq, F. Vuotto, A. Chabrol, J. Cabalion, S. Tubiana, F. Mentré, C. Laouénan, I. Gorenne, E. Marcault, P. Manchon, B. Pasquet, C. Roy

Funding

The cohort was funded by the French ministry of health, APHP DRCI, Inserm, French society of infectious diseases, and Pfizer pharmaceutical company.

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Correspondence to Xavier Duval.

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Conflict of interest

We have read and understood the Infection policy on declaration of interests and have no relevant interests to declare.

Ethics approval

The study was approved by the institutional Ethics Committee Ile-de-France 4 (IRB #00003835, approval #2012-16NI) and by the French Data Protection Authority (approval ECY/FLR/AR128794).

Consent to participate

All participants provided consent to participate before entering the study.

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Not applicable.

Additional information

The members of the COMBAT study group are mentioned in Acknowledgements section.

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Akroum, S., Tubiana, S., de Broucker, T. et al. Long-term neuro-functional disability in adult patients with community-acquired bacterial meningitis. Infection (2022). https://doi.org/10.1007/s15010-022-01855-2

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Keywords

  • Bacterial meningitidis
  • Neuro-functional disability
  • Cohort study
  • Physical disability
  • Functional disability