Outcome of fulminant bacterial meningitis in adult patients

Background and purpose The objective of our study was to identify neurological factors associated with poor outcome in adult patients with fulminant bacterial meningitis. Methods This was a retrospective review of consecutive adult patients with fulminant bacterial meningitis, defined as meningitis causing coma within 24–48 h of hospitalization, at Mayo Clinic Rochester between January 2000 and November 2010. Functional status was assessed at discharge and upon last follow-up using the modified Rankin scale (mRS). The primary end-point was death or new major disability (increase of >2 on the mRS) at last follow-up. Results Thirty-nine patients were identified. Encephalopathy (44%), coma (28%), focal seizures (3%) or a combination of these (26%) were present on admission. The most common pathogen was Streptococcus pneumoniae (57%). All patients were treated with broad spectrum antibiotics and 51% received steroids. Serious systemic complications were seen in 23 patients. Sixteen patients (41%) died during hospitalization. Median mRS at hospital discharge for surviving patients was 3; four patients had new major disability with a mean follow-up of 11 months. Predictors of death or new major disability included lower Glasgow Coma Scale score at nadir [P = 0.002; age- and sex-adjusted odds ratio (OR) 0.46, 95% confidence interval (CI) 0.28–0.48], longer duration of symptoms before hospitalization (P = 0.045; adjusted OR 2.34, 95% CI 1.02–5.37), abnormal head imaging at presentation (P = 0.008; adjusted OR 9.40, 95% CI 1.78−49.6) and use of intracranial pressure monitoring (P = 0.010, adjusted OR 51.0, 95% CI 2.51−1036). Conclusion Many adult patients who survive hospitalization are able to regain their pre-morbid level of function. Aggressive management of bacterial meningitis is justified even in comatose adult patients.