Delayed Cerebral Injury in Adults With Bacterial Meningitis: A Novel Complication of Adjunctive Steroids?

Objectives: To report the prevalence of delayed cerebral injury in adults with bacterial meningitis and explore its association with adjunctive steroids. Design: Retrospective analysis of adults with bacterial meningitis between 2005 and 2016. Setting: Ten hospitals in the Greater Houston area. Patients: Consecutive subjects with culture proven community-acquired bacterial meningitis. Intervention: Subjects were categorized as receiving or not adjunctive steroids within 4 hours. Measurements and Main Results: A total of 120 patients were identified who were admitted with community-acquired bacterial meningitis. Delayed cerebral injury was seen in five of 120 patients (4.1%); all five patients had fever and abnormal neurologic examinations. Adjunctive steroids within 4 hours were more likely given to those with delayed cerebral injury (5/5,100% vs 43/115, 37.5%; p = 0.01). Of the patients who developed delayed cerebral injury, three had Streptococcus pneumoniae, one had methicillin-resistant Staphylococcus aureus, and one had Listeria monocytogenes isolated. We observed an adverse clinical outcome as defined by the Glasgow Outcome Scale in four of the five patients (80%). Conclusions: Delayed cerebral injury occurred in 4.1% of adults with bacterial meningitis, and it was associated with the use of adjunctive steroids. Future studies should explore the etiology and prevention of this devastating complication. Drs. Gallegos, Nigo, and Tobowlosky screened the patients and did the data collection. Dr. Gallegos created the first draft of the article. Dr. Hasbun designed the study. Dr. Hasbun participated in the data interpretation and edited the article. Dr. Hasbun wrote the final draft of the article and made all the changes suggested by the coauthors. Supported, in part, by Grant A Starr Foundation. Dr. Hasbun is a consultant for bioMérieux and a speaker for Pfizer, Merck, Medicines Company, and BioFire. Dr. Hasbun received funding from BioFire Diagnostics, Biomeriaux, and Merck. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Rodrigo.Hasbun@uth.tmc.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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