Abstract
We studied causative pathogens, clinical characteristics, and outcome of adult community-acquired bacterial meningitis after the introduction of adjunctive dexamethasone treatment and nationwide implementation of paediatric conjugate vaccines. In this cohort study, we prospectively assessed adults (age >16 years) with community-acquired bacterial meningitis in the Netherlands, identified through the National Reference Laboratory for Bacterial Meningitis or individual physicians between Jan 1, 2006, and July 1, 2014. We identified independent predictors of an unfavourable outcome (Glasgow Outcome Scale score 1-4) by logistic regression. We assessed 1412 episodes of community-acquired bacterial meningitis. Incidence declined from 1·72 cases per 100,000 adults per year in 2007-08, to 0·94 per 100,000 per year in 2013-14. Streptococcus pneumoniae caused 1017 (72%) of 1412 episodes. Rates of adult bacterial meningitis decreased most sharply among pneumococcal serotypes included in paediatric conjugate vaccine, and in meningococcal meningitis. We found no evidence of serotype or serogroup replacement. The overall case fatality rate was 244 (17%) of 1412 episodes and unfavourable outcome occurred in 531 (38%) of 1412 episodes. Predictors of unfavourable outcome were advanced age, absence of otitis or sinusitis, alcoholism, tachycardia, lower score on the Glasgow Coma Scale, cranial nerve palsy, a cerebrospinal fluid white-cell count lower than 1000 cells per μL, a positive blood culture, and a high serum C-reactive protein concentration. Adjunctive dexamethasone was administered for 1234 (89%) of 1384 assessed episodes. The multivariable adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0·54 (95% CI 0·39-0·73). The incidence of adult bacterial meningitis has decreased substantially, which is partly explained by herd protection by paediatric conjugate vaccines. Adjunctive dexamethasone treatment was associated with substantially improved outcome. European Research Council, National Institute of Public Health and the Environment, European Union, Academic Medical Center, and Netherlands Organization for Health Research and Development
| Original language | English |
|---|---|
| Pages (from-to) | 339-347 |
| Number of pages | 9 |
| Journal | Lancet infectious diseases |
| Volume | 16 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2016 |
Keywords
- Adolescent
- Adult
- Aged
- Anti-Inflammatory Agents/therapeutic use
- Bacteria/classification
- Cohort Studies
- Community-Acquired Infections/drug therapy
- Dexamethasone/therapeutic use
- Female
- Humans
- Incidence
- Male
- Meningitis, Bacterial/drug therapy
- Middle Aged
- Netherlands/epidemiology
- Odds Ratio
- Serogroup
- Time Factors
- Treatment Outcome
- Young Adult
Access to Document
Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
Bijlsma, M. W., Brouwer, M. C., Kasanmoentalib, E. S., Kloek, A. T., Lucas, M. J., Tanck, M. W., van der Ende, A. (2016). Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study: a prospective cohort study. Lancet infectious diseases, 16(3), 339-347. https://doi.org/10.1016/S1473-3099(15)00430-2
Bijlsma, Merijn W. ; Brouwer, Matthijs C. ; Kasanmoentalib, E. Soemirien et al. / Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study : a prospective cohort study. In: Lancet infectious diseases. 2016 ; Vol. 16, No. 3. pp. 339-347.
@article{c87e3494774240a89536c9cfd6242146,
title = "Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study: a prospective cohort study",
abstract = "We studied causative pathogens, clinical characteristics, and outcome of adult community-acquired bacterial meningitis after the introduction of adjunctive dexamethasone treatment and nationwide implementation of paediatric conjugate vaccines. In this cohort study, we prospectively assessed adults (age >16 years) with community-acquired bacterial meningitis in the Netherlands, identified through the National Reference Laboratory for Bacterial Meningitis or individual physicians between Jan 1, 2006, and July 1, 2014. We identified independent predictors of an unfavourable outcome (Glasgow Outcome Scale score 1-4) by logistic regression. We assessed 1412 episodes of community-acquired bacterial meningitis. Incidence declined from 1·72 cases per 100,000 adults per year in 2007-08, to 0·94 per 100,000 per year in 2013-14. Streptococcus pneumoniae caused 1017 (72%) of 1412 episodes. Rates of adult bacterial meningitis decreased most sharply among pneumococcal serotypes included in paediatric conjugate vaccine, and in meningococcal meningitis. We found no evidence of serotype or serogroup replacement. The overall case fatality rate was 244 (17%) of 1412 episodes and unfavourable outcome occurred in 531 (38%) of 1412 episodes. Predictors of unfavourable outcome were advanced age, absence of otitis or sinusitis, alcoholism, tachycardia, lower score on the Glasgow Coma Scale, cranial nerve palsy, a cerebrospinal fluid white-cell count lower than 1000 cells per μL, a positive blood culture, and a high serum C-reactive protein concentration. Adjunctive dexamethasone was administered for 1234 (89%) of 1384 assessed episodes. The multivariable adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0·54 (95% CI 0·39-0·73). The incidence of adult bacterial meningitis has decreased substantially, which is partly explained by herd protection by paediatric conjugate vaccines. Adjunctive dexamethasone treatment was associated with substantially improved outcome. European Research Council, National Institute of Public Health and the Environment, European Union, Academic Medical Center, and Netherlands Organization for Health Research and Development",
keywords = "Adolescent, Adult, Aged, Anti-Inflammatory Agents/therapeutic use, Bacteria/classification, Cohort Studies, Community-Acquired Infections/drug therapy, Dexamethasone/therapeutic use, Female, Humans, Incidence, Male, Meningitis, Bacterial/drug therapy, Middle Aged, Netherlands/epidemiology, Odds Ratio, Serogroup, Time Factors, Treatment Outcome, Young Adult",
author = "Bijlsma, {Merijn W.} and Brouwer, {Matthijs C.} and Kasanmoentalib, {E. Soemirien} and Kloek, {Anne T.} and Lucas, {Marjolein J.} and Tanck, {Michael W.} and {van der Ende}, Arie and {van de Beek}, Diederik",
year = "2016",
month = mar,
doi = "https://doi.org/10.1016/S1473-3099(15)00430-2",
language = "English",
volume = "16",
pages = "339--347",
journal = "Lancet infectious diseases",
issn = "1473-3099",
publisher = "Lancet Publishing Group",
number = "3",
}
Bijlsma, MW, Brouwer, MC, Kasanmoentalib, ES, Kloek, AT, Lucas, MJ, Tanck, MW, van der Ende, A 2016, 'Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study: a prospective cohort study', Lancet infectious diseases, vol. 16, no. 3, pp. 339-347. https://doi.org/10.1016/S1473-3099(15)00430-2
Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study: a prospective cohort study. / Bijlsma, Merijn W.; Brouwer, Matthijs C.; Kasanmoentalib, E. Soemirien et al.
In: Lancet infectious diseases, Vol. 16, No. 3, 03.2016, p. 339-347.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study
T2 - a prospective cohort study
AU - Bijlsma, Merijn W.
AU - Brouwer, Matthijs C.
AU - Kasanmoentalib, E. Soemirien
AU - Kloek, Anne T.
AU - Lucas, Marjolein J.
AU - Tanck, Michael W.
AU - van der Ende, Arie
AU - van de Beek, Diederik
PY - 2016/3
Y1 - 2016/3
N2 - We studied causative pathogens, clinical characteristics, and outcome of adult community-acquired bacterial meningitis after the introduction of adjunctive dexamethasone treatment and nationwide implementation of paediatric conjugate vaccines. In this cohort study, we prospectively assessed adults (age >16 years) with community-acquired bacterial meningitis in the Netherlands, identified through the National Reference Laboratory for Bacterial Meningitis or individual physicians between Jan 1, 2006, and July 1, 2014. We identified independent predictors of an unfavourable outcome (Glasgow Outcome Scale score 1-4) by logistic regression. We assessed 1412 episodes of community-acquired bacterial meningitis. Incidence declined from 1·72 cases per 100,000 adults per year in 2007-08, to 0·94 per 100,000 per year in 2013-14. Streptococcus pneumoniae caused 1017 (72%) of 1412 episodes. Rates of adult bacterial meningitis decreased most sharply among pneumococcal serotypes included in paediatric conjugate vaccine, and in meningococcal meningitis. We found no evidence of serotype or serogroup replacement. The overall case fatality rate was 244 (17%) of 1412 episodes and unfavourable outcome occurred in 531 (38%) of 1412 episodes. Predictors of unfavourable outcome were advanced age, absence of otitis or sinusitis, alcoholism, tachycardia, lower score on the Glasgow Coma Scale, cranial nerve palsy, a cerebrospinal fluid white-cell count lower than 1000 cells per μL, a positive blood culture, and a high serum C-reactive protein concentration. Adjunctive dexamethasone was administered for 1234 (89%) of 1384 assessed episodes. The multivariable adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0·54 (95% CI 0·39-0·73). The incidence of adult bacterial meningitis has decreased substantially, which is partly explained by herd protection by paediatric conjugate vaccines. Adjunctive dexamethasone treatment was associated with substantially improved outcome. European Research Council, National Institute of Public Health and the Environment, European Union, Academic Medical Center, and Netherlands Organization for Health Research and Development
AB - We studied causative pathogens, clinical characteristics, and outcome of adult community-acquired bacterial meningitis after the introduction of adjunctive dexamethasone treatment and nationwide implementation of paediatric conjugate vaccines. In this cohort study, we prospectively assessed adults (age >16 years) with community-acquired bacterial meningitis in the Netherlands, identified through the National Reference Laboratory for Bacterial Meningitis or individual physicians between Jan 1, 2006, and July 1, 2014. We identified independent predictors of an unfavourable outcome (Glasgow Outcome Scale score 1-4) by logistic regression. We assessed 1412 episodes of community-acquired bacterial meningitis. Incidence declined from 1·72 cases per 100,000 adults per year in 2007-08, to 0·94 per 100,000 per year in 2013-14. Streptococcus pneumoniae caused 1017 (72%) of 1412 episodes. Rates of adult bacterial meningitis decreased most sharply among pneumococcal serotypes included in paediatric conjugate vaccine, and in meningococcal meningitis. We found no evidence of serotype or serogroup replacement. The overall case fatality rate was 244 (17%) of 1412 episodes and unfavourable outcome occurred in 531 (38%) of 1412 episodes. Predictors of unfavourable outcome were advanced age, absence of otitis or sinusitis, alcoholism, tachycardia, lower score on the Glasgow Coma Scale, cranial nerve palsy, a cerebrospinal fluid white-cell count lower than 1000 cells per μL, a positive blood culture, and a high serum C-reactive protein concentration. Adjunctive dexamethasone was administered for 1234 (89%) of 1384 assessed episodes. The multivariable adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0·54 (95% CI 0·39-0·73). The incidence of adult bacterial meningitis has decreased substantially, which is partly explained by herd protection by paediatric conjugate vaccines. Adjunctive dexamethasone treatment was associated with substantially improved outcome. European Research Council, National Institute of Public Health and the Environment, European Union, Academic Medical Center, and Netherlands Organization for Health Research and Development
KW - Adolescent
KW - Adult
KW - Aged
KW - Anti-Inflammatory Agents/therapeutic use
KW - Bacteria/classification
KW - Cohort Studies
KW - Community-Acquired Infections/drug therapy
KW - Dexamethasone/therapeutic use
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Meningitis, Bacterial/drug therapy
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Odds Ratio
KW - Serogroup
KW - Time Factors
KW - Treatment Outcome
KW - Young Adult
U2 - https://doi.org/10.1016/S1473-3099(15)00430-2
DO - https://doi.org/10.1016/S1473-3099(15)00430-2
M3 - Article
C2 - 26652862
SN - 1473-3099
VL - 16
SP - 339
EP - 347
JO - Lancet infectious diseases
JF - Lancet infectious diseases
IS - 3
ER -
Bijlsma MW, Brouwer MC, Kasanmoentalib ES, Kloek AT, Lucas MJ, Tanck MW et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study: a prospective cohort study. Lancet infectious diseases. 2016 Mar;16(3):339-347. doi: https://doi.org/10.1016/S1473-3099(15)00430-2
