Meningitis: bacterial: death and complications were common.

Clinical bottom line (level 4)

  1. Half of patients with bacterial meningitis developed complications.
  2. A fifth died and a tenth were left with severe disability.
Pfister et al: Archives of Neurology 1993; 50: 575-581
Expires November 2003

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: tertiary neurology department, university hospital, Germany

86 patients (aged 15 to 87, 54% male) with bacterial meningitis (diagnosed on CSF culture, Gram stain or latex agglutination; or an elevated white cell count and clinical features of meningitis)

Excluded if
  • purulent meningitis due to a primary intracranial bacterial suppurative infection (brain abscess or empyema)


    • All patients received intravenous antibiotics

    ?100% followed for to discharge
    Outcomes studied:
  • death
  • vegetative state or severe disability
  • any complication
  • seizures
  • focal neurological signs

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death to discharge 16/86 19%
    (11% to 27%)
    vegetative state or severe disability to discharge 9/86 11%
    (4.0% to 17%)
    any complication to discharge 43/86 50%
    (39% to 61%)
    seizures to discharge 21/86 24%
    (15% to 34%)
    focal neurological signs to discharge 24/86 28%
    (18% to 37%)

    Comments

    1. 45% of patients were referred from another hospital
    2. Difficult to be very clear of the results without validated disability scales

    Citation

    1. Pfister H-W, Feiden W, Einhaupl K-M: spectrum of complications during bacterial meningitis: results of a prospective clinical study. Archives of Neurology 1993; 50: 575-581
    Search Terms:
    Contributor: Chris Ball and Bob Phillips, November 1999
    Reviewer: Luis Ruiz Del Fresno

    Clinical Question.
    Patient bacterial meningitis
    Intervention or Exposure meningitis
    Outcome death, neurological complications