Update on community-acquired bacterial meningitis: guidance and challenges

C N van Ettekoven; D van de Beek; M C Brouwer

doi:10.1016/j.cmi.2017.04.019

Update on community-acquired bacterial meningitis: guidance and challenges

Clin Microbiol Infect. 2017 Sep;23(9):601-606. doi: 10.1016/j.cmi.2017.04.019. Epub 2017 May 3.

Authors

C N van Ettekoven¹, D van de Beek¹, M C Brouwer²

Affiliations

¹ Departments of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands.
² Departments of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: m.c.brouwer@amc.uva.nl.

PMID: 28478238
DOI: 10.1016/j.cmi.2017.04.019

Abstract

Background: The existing heterogeneity in diagnostic work-up and treatment strategies in bacterial meningitis was the incentive to develop a European evidence-based guideline, which was published in 2016 by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Infections of the Brain (ESGIB).

Aims: To summarize salient features of the guideline, identify recent developments and challenges currently faced.

Sources: The ESCMID guideline, ongoing trial registries.

Content: Epidemiology, clinical symptoms, diagnostic work-up and therapy strategies of acute bacterial meningitis.

Implications: The incidence of bacterial meningitis has decreased following pneumococcal and meningococcal conjugate vaccine introduction. In the diagnosis of bacterial meningitis the clinical characteristics and laboratory parameters are of limited diagnostic accuracy and therefore cerebrospinal fluid analysis remains the principal contributor to the final diagnosis. The ESCMID guideline advises to start empiric treatment within one hour of arrival in all suspected meningitis cases, and choice of antibiotics needs to be differentiated according to the patient's age, risk factors, and local resistance rates of pneumococci. Dexamethasone is the only proven adjunctive treatment and should be started together with the antibiotics. The follow-up of surviving patients should include evaluation for hearing loss and pneumococcal vaccination to prevent recurrences. Future perspectives include further development and implementation of vaccines, and new treatments aimed at further reducing the inflammatory response. Studies on implementation of the new guideline should determine adherence and evaluate whether improved prognosis can be achieved by following protocolled management strategies.

Keywords: Antibiotic treatment; Bacterial meningitis; Dexamethasone; Diagnosis; ESCMID guideline; Epidemiology; Randomized controlled trials.

Publication types

Review

MeSH terms

Community-Acquired Infections* / diagnosis
Community-Acquired Infections* / drug therapy
Humans
Meningitis, Bacterial* / diagnosis
Meningitis, Bacterial* / drug therapy
Practice Guidelines as Topic

Grants and funding

281156/ERC_/European Research Council/International