TY - JOUR
T1 - Adjunctive dexamethasone treatment in adults with listeria monocytogenes meningitis
T2 - a prospective nationwide cohort study
AU - Brouwer, Matthijs C.
AU - van de Beek, Diederik
N1 - Funding Information: We thank all participating physicians in the Netherlands for their cooperation. Supported by grants from the European Research Council (ERC Consolidator grant 101001237 to MB), and the Netherlands Organisation for Health Research and Development (Vici grant number 918.19.627 to DvdB; Vidi grant number 917.17.308 to MB). Funding Information: European Research Council and Netherlands Organisation for Health Research and DevelopmentMCB is supported by research grants of the European Research Council, Netherlands Organisation for Health Research and Development and stichting de Merel. MCB is supported for travel and attending the ECCMID by the European Society of Clinical Microbiology and Infectious Disease (ESCMID). MCB participates in the Trial Steering Committee of the ENCEPH-UK trial and chairs the ESCMID study group on infections of the brain. DvdB is supported by a research grant of the Netherlands Organization for Health Research and Development. DvdB participates in the Trial Steering Committee of the DEX-ENCEPH trial.We thank all participating physicians in the Netherlands for their cooperation. Supported by grants from the European Research Council (ERC Consolidator grant 101001237 to MB), and the Netherlands Organisation for Health Research and Development (Vici grant number 918.19.627 to DvdB; Vidi grant number 917.17.308 to MB). Publisher Copyright: © 2023 The Author(s)
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background: A French cohort study described a detrimental effect of adjunctive dexamethasone treatment in listeria meningitis. Based on these results guidelines recommend not to use dexamethasone if L. monocytogenes is suspected or stop dexamethasone when the pathogen is detected. We studied clinical characteristics, treatment regimens and outcome of adults with Listeria monocytogenes meningitis in a nationwide cohort study on bacterial meningitis. Methods: We prospectively assessed adults with community-acquired L. monocytogenes meningitis in the Netherlands between Jan 1, 2006, and July 1, 2022. We identified independent predictors for an unfavourable outcome (Glasgow Outcome Scale score 1 to 4) and mortality by logistic regression. Findings: 162 out of 2664 episodes (6%) of community-acquired bacterial meningitis episode were caused by L. monocytogenes in 162 patients. Adjunctive dexamethasone 10 mg QID was started with the first dose of antibiotics in 93 of 161 patients (58%) and continued for the full four days in 83 (52%) patients. Different doses, duration or timing of dexamethasone were recorded in 11 patients (7%) and 57 patients (35%) did not receive dexamethasone. The case fatality rate was 51 of 162 (31%) and an unfavourable outcome occurred in 91 of 162 patients (56%). Age and the standard regimen of adjunctive dexamethasone were independent predictors for an unfavourable outcome and mortality. The adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0.40 (95% confidence interval 0.19–0.81). Interpretation: Adjunctive dexamethasone is associated with an improved outcome in patients with L. monocytogenes meningitis and should not be withheld if L. monocytogenes is suspected or detected as causative pathogen.
AB - Background: A French cohort study described a detrimental effect of adjunctive dexamethasone treatment in listeria meningitis. Based on these results guidelines recommend not to use dexamethasone if L. monocytogenes is suspected or stop dexamethasone when the pathogen is detected. We studied clinical characteristics, treatment regimens and outcome of adults with Listeria monocytogenes meningitis in a nationwide cohort study on bacterial meningitis. Methods: We prospectively assessed adults with community-acquired L. monocytogenes meningitis in the Netherlands between Jan 1, 2006, and July 1, 2022. We identified independent predictors for an unfavourable outcome (Glasgow Outcome Scale score 1 to 4) and mortality by logistic regression. Findings: 162 out of 2664 episodes (6%) of community-acquired bacterial meningitis episode were caused by L. monocytogenes in 162 patients. Adjunctive dexamethasone 10 mg QID was started with the first dose of antibiotics in 93 of 161 patients (58%) and continued for the full four days in 83 (52%) patients. Different doses, duration or timing of dexamethasone were recorded in 11 patients (7%) and 57 patients (35%) did not receive dexamethasone. The case fatality rate was 51 of 162 (31%) and an unfavourable outcome occurred in 91 of 162 patients (56%). Age and the standard regimen of adjunctive dexamethasone were independent predictors for an unfavourable outcome and mortality. The adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0.40 (95% confidence interval 0.19–0.81). Interpretation: Adjunctive dexamethasone is associated with an improved outcome in patients with L. monocytogenes meningitis and should not be withheld if L. monocytogenes is suspected or detected as causative pathogen.
KW - Bacterial meningitis
KW - Dexamethasone
KW - Listeria monocytogenes
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85150887810&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.eclinm.2023.101922
DO - https://doi.org/10.1016/j.eclinm.2023.101922
M3 - Article
C2 - 37007737
SN - 2589-5370
VL - 58
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 101922
ER -