July 13, 2020

An article review from the ESICM Journal Review Club

A review on the Epidemiology and  Management of Acute Bacterial Meningitis, Acute Meningitis and Healthcare-Associated Ventriculitis and Meningitis.

Infectious meningitis and encephalitis are a major concern in ICU since they are associated with high mortality and permanent neurological injury. About 3% of central nervous system infections will be admitted in the ICU.

Three credible experts (Geert Meyfroidt, Pedro Kurtz and Romain Sonneville) propose a review on the epidemiology and the management of acute bacterial meningitis, acute meningitis and healthcare-associated ventriculitis and meningitis. They detail the most recent data on epidemiology and especially the impact of vaccination of acute bacterial meningitis, the high rate of non-infectious immune-mediated encephalitis among acute meningoencephalitis (20% of causes presenting to hospital) and the incidence of healthcare-associated ventriculitis and meningitis associated to external ventricular drains.

A schematic overview of the most common pathogens is presented in a Table (copied below) and diagnostic workup is detailed and nicely summarised in a diagnostic algorithm (also copied below).

The final part focuses on the management and encompasses the antimicrobial treatment and adjunctive treatment strategies.

An updated view is given on intracranial hypertension (recommended) and temperature management (not recommended), the treatment of seizures and the administration of glycerol.

The ICU admission of those patients is mandatory to treat, but also to prevent systemic and neurological complications.

 

STUDY STRENGTHS & LIMITATIONS

A good overview of the management of infectious meningitis and encephalitis made by three experts.

The Table with the most common pathogen is helpful, as is the summarised diagnostic algorithm.

As all general reviews, some details are omitted, but these can be found in the articles that are cited.

TAKE HOME MESSAGE

Infectious meningitis and encephalitis are frequent in ICU. ICU admission is necessary to prevent and treat systemic and neurological complications.  An easy diagnostic algorithm is able to help to identify correctly infectious meningitis and encephalitis.

Correct identification ensures the adequate management of the situation.

 

This article review was prepared and submitted by Dr Nicolas Weiss, Associate Professor in Therapeutics and Critical Care at Sorbonne University, La Pitie-Salpetriere Hospital, Paris, France, on behalf of the ESICM Journal Review Club.


REFERENCES
  1. CMI (Clinical Microbiology & Infection) Volume 22, Supplement 3, S37-S62, May 01, 2016 ESCMID Guideline: diagnosis and treatment of acute bacterial meningitis

 

 

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