Abstract
Meningitis is the most common worldwide infection of the central nervous system, and bacterial meningitis is a potentially life-threatening disease that requires immediate recognition and treatment. Community-acquired bacterial meningitis has an annual incidence of 4–6 cases per 100,000 adults, and Streptococcus pneumoniae and Neisseria meningitidis are responsible for at least 80% of all cases [1], [2]. In a surveillance study conducted in 1995 in USA, the incidence of bacterial meningitis was found to have declined dramatically [2]. This finding was a result of a vaccine-related decline in meningitis caused by Haemophilus influenzae type B vaccine; in the USA and in other industrialised countries, bacterial meningitis is now a disease predominantly of adults rather than infants and children. Moreover, conjugate vaccines against S. pneumoniae are expected to reduce the incidence of childhood pneumococcal meningitis significantly [3]. Bacterial meningitis is also an important problem in hospitalised patients. In a review of 493 episodes of bacterial meningitis in adults at a USA tertiary hospital from 1962 to 1988 inclusive, 40% of episodes were nosocomial in origin, with most cases (38%) caused by Gram-negative bacilli. In that study, the mortality rate remained high over time, and even in the 1980s, almost one quarter of adults with meningitis died, despite the advances in antibiotic therapy. In contrast, it was found that the mortality rate of Gram-negative bacillary meningitis had decreased since the advent of third-generation cephalosporins [4].
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References
van de Beek D, de Gans J, Spanjaard L et al (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859
Schuchat A, Robinson K, Wenger JD et al (1997) Bacterial meningitis in the United States in 1995. N Engl J Med 337:970–976
Whitney CG, Farley MM, Hadler MM et al (2003) Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348:1737–1746
Durand M, Calderwood SB, Weber DJ et al (1993) Acute bacterialmeningitis in adults—a review of 493 episodes. N Engl J Med 328:21–28
Flores-Cordero JM, Amaya-Villar R, Rincon-Ferrari MD et al (2003) Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Intensive Care Med 29:1967–1973
Butler JC, Hofmann J, Cetron MS et al (1996) The continued emergence of drug-resistant Streptococcus pneumoniae the United States: an update from the Centers for Disease Control and Prevention’s pneumococcal sentinel surveillance system. J Infect Dis 174:986–993
Song JH, Lee NY, Ichiyama S et al and the ANSORP Study Group (1999) Spread of drug-resistant Streptococcus pneumoniae in Asian countries: Asian Network for Surveillance of Resistant Pathogens (ANSORP) study. Clin Infect Dis 28:1208–1211
Bedos JP, Chevret S, Chastang C et al and the French Cooperative Pneumococcus Study Group (1996) Epidemiological features of and risk factors for infection by Streptococcus pneumoniae strains with diminished susceptibility to penicillin: findings of a French survey. Clin Infect Dis 22:63–72
Hofmann J, Cetron MS, Farley MM et al (1995) The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med 333:481–486
American Academy of Pediatrics (1997) Therapy for children for invasive pneumococcal infection. Pediatrics 99:289–299
Tunkel AR, Hartman BJ, Kaplan SL et al (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284
Reinert RR, Reinert S, van der Linden M et al (2005) Antimicrobial susceptibility of Streptococcus pneumoniae in eight European countries from 2001 to 2003. Antimicrob Agents Chemother 49:2903–2913
Casado-Flores J, Osona B, Comingo P et al (1997) Meningococcal meningitis during penicillin therapy for meningococcemia. Clin Infect Dis 25:1479
Tunkel AR, Scheld WM (2005) Acute meningitis. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases. Elsevier/Churchill Livingstone, Philadelphia, USA, pp 1083–1126
Lorber B (1997) Listeriosis. Clin Infect Dis 24:1–11
Bouadma L, Schortgen F, Thomas R et al (2006) Adults with spontaneous aerobic Gram-negative bacillary meningitis admitted to the intensive care unit. Clin Microb Infect 12:287–290
Aronin SI, Peduzzi P, Quagliarello VJ (1998) Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 129:862–869
van de Beek D, de Gans J, Tunkel A et al (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354:44–53
Proulx N, Frechette D, Toye B et al (2005) Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Q J Med 98:291–298
Talan DA, Guterman JJ, Overturf GD et al (1989) Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med 18:856–862
Fiore AE, Moroney JF, Farley MM et al (2000) Clinical outcomes of meningitis caused by Streptococcus pneumoniae in the era of antibiotic resistance. Clin Infect Dis 30:71–77
Scheld WM, Dacey RG, Winn HR et al (1980) Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alteration with penicillin and methylprednisolone. J Clin Invest 66:243–253
Tauber MG, Khayam-Bashi H, Sande MA (1985) Effects of ampicillin and corticosteroids on brain water content, cerebrospinal fluid pressure, and cerebrospinal fluid lactate levels in experimental pneumococcal meningitis. J Infect Dis 151:528–534
van de Beek D, de Gans J, McIntyre P et al (2003) Corticosteroids in acute bacterial meningitis. (The Cochrane Library) John Wiley & Sons, Chichester, UK, issue 4
de Gans J, van de Beek D (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347:1549–1556
van de Beek D, de Gans J, McIntyre P et al (2004) Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis 4:139–143
Annane D, Sebille V, Charpentier C et al (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871
Auburtin M, Porcher R, Bruneel F et al (2002) Pneumococcal meningitis in the intensive care unit. Prognostic factors of clinical outcome in a series of 80 cases. Am J Respir Crit Care Med 165:713–717
De Lalla F, Nicolin R, Lazzarin L (2000) Safety and efficacy of recombinant granulocyte colony-stimulating factors as adjunctive therapy for Streptococcus pneumoniae meningitis in non-neutropenic adult: a pilot study. J Antimicrob Chemother 46:843–846
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Luzzati, R., Giacomazzi, D. (2007). Focus on the diagnosis and treatment of severe meningitis. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0571-6_16
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DOI: https://doi.org/10.1007/978-88-470-0571-6_16
Publisher Name: Springer, Milano
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