Dexamethasone for adult community-acquired bacterial meningitis: 20 years of experience in daily practice

Znanstveni rad - Izvorni znanstveni rad

• Autor: Vjerislav Peterković
• Autor: Vladimir Trkulja
• Autor: Marko Kutleša
• Autor: Vladimir Krajinović
• Autor: Dragan Lepur
• Autorova ustanova: Sveučilište u Zagrebu; Medicinski fakultet
• Znanstveno / umjetničko područje, polje i grana: BIOMEDICINA I ZDRAVSTVO; Kliničke medicinske znanosti

Sažetak (engleski)

The aim of the study was to assess adjunctive intravenous dexamethasone in adult community-acquired bacterial meningitis (BM) in daily practice. Analysis of consecutive patients (1990-2009) with acute community-acquired bacterial meningitis in a single centre in Zagreb, Croatia, N = 304. Adjusted relative risks [RR, dexamethasone vs. no dexamethasone (control)] of Glasgow Outcome Scale (GOS) = 1 (death) and GOS = 5 (full recovery) at discharge/end of specific treatment were estimated considering demographics; co-morbidity; BM pathogenesis and on-admission characteristics, and cerebrospinal fluid (CSF) inflammation markers; causative agent and antibiotic use. Two hundred forty (79%) patients had proven BM (43.1% Streptococcus pneumoniae, any other agent ≤ 8.2%). No independent effects of dexamethasone on GOS = 1 or GOS = 5 were observed in the entire cohort (dexamethasone n = 119, control n = 185; RR = 1.06, 95% CI 0.77-1.45 and RR = 0.99, CI 0.83-1.20, respectively), microbiologically proven disease (dexamethasone n = 104, control n = 136; RR = 0.97, CI 0.69-1.38 and RR = 1.03, CI 0.82-1.28), pneumococcal disease (dexamethasone n = 71, control n = 60; RR = 0.95, CI 0.53-1.70 and RR = 0.82, CI 0.57-1.18), and also in other BM, subgroups based on consciousness disturbance, CSF markers, prior use of antibiotics and timing of appropriate antibiotic treatment. CSF markers did not predict the outcomes. Conclusions: Our experience does not substantiate the reported benefits of adjunctive dexamethasone in adult BM. Socio-economic and methodological factors do not seem to explain this discrepancy. Empirical use of dexamethasone in this setting appears controversial.

• Ključne riječi (engleski): Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents/therapeutic use; Chemotherapy, Adjuvant; Community-Acquired Infections/cerebrospinal fluid; Community-Acquired Infections/drug therapy; Dexamethasone/therapeutic use; Female; Glasgow Outcome Scale; Humans; Inflammation/cerebrospinal fluid; Inflammation/drug therapy; Male; Meningitis, Bacterial/cerebrospinal fluid; Meningitis, Bacterial/drug therapy; Middle Aged; Recovery of Function/drug effects; Young Adult
• Jezik: engleski
• Vrsta publikacije: Znanstveni rad - Izvorni znanstveni rad
• Status objave: Objavljen
• Vrsta recenzije: Recenziran
• Verzija publikacije: Završna verzija rukopisa prihvaćena za objavljivanje (postprint)
• Naslov časopisa: Journal of Neurology
• Brojčani podaci: vol. 259, br. 2, str. 225-236
• p-ISSN: 0340-5354
• DOI: https://doi.org/10.1007/s00415-011-6150-6
• URN:NBN: urn:nbn:hr:105:239641
• Datum objave publikacije: 2012-02
• URL dokumenta: https://doi.org/10.1007/s00415-011-6150-6
• Vrsta resursa: Tekst
• Prava pristupa: Otvoreni pristup
• Datum i vrijeme pohrane: 2024-03-27 19:32:03