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1Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Porto, Portugal
2Department of Intensive Care, Centro Hospitalar Universitário do Porto, Porto, Portugal
3Department of Emergency, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
4Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
5CriticalMed Cintesis, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Copyright © 2022 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: SRV, CT, LSF, CG, CT. Data curation: SRV, CT, LSF, DM. Formal analysis: SRV, CT, LSF, DM, CG. Methodology: SRV, CT, LSF, DM. Project administration: SRV, CT. Validation: SRV, CT, CG. Visualization: SRV, CT. Writing–original draft: SRV, CT, LSF, DM. Writing–review & editing: SRV, CT, LSF, CG, CT.
Treatment | Value |
---|---|
Empirical antimicrobial therapy | |
Ceftazidime plus vancomycin | 42 (60) |
Meropenem plus vancomycin | 22 (31.4) |
Route of therapy | |
Intravenous only | 69 (98.6) |
Intravenous and intraventricular | 1 (1.4) |
Duration of antibiotic therapy (day)a | 18.0±8.3 |
Other therapeutic measure | |
Corticoid | 13 (19.4) |
Intracranial hypertension management | |
Antiedematous therapy | 8 (11.4) |
Barbiturate coma therapy | 2 (2.8) |
CSF shunt | 11 (15.7) |
Craniectomy | 2 (2.9) |
Neurosurgery for infection control | 4 (5.7) |
Removal of CNS device | 2 (2.9) |
Closure of CSF fistula | 1 (1.4) |
Variable |
Any complication |
Non-alert at dischargea |
30-Day mortality and hospital mortality |
|||
---|---|---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | |
Demographics and underlying disease | ||||||
Age ≥65 yr | 0.71 (0.26–1.93) | 0.51 | 1.30 (0.28–5.73) | 0.71 | 8.89 (2.42–32.68) | 0.001 |
Male | 1.06 (0.40–2.82) | 0.90 | 7.60 (0.89–64.62) | 0.04 | 0.86 (0.27–2.76) | 1 |
Previous partially dependent | 0.53 (0.09–3.12) | 0.68 | 0.80 (0.69–0.91) | 1 | 9.64 (1.57–59.32) | 0.02 |
Immunocompromised | 0.80 (0.29–2.19) | 0.67 | 1.98 (0.51–7.68) | 0.47 | 1.03 (0.31–3.46) | 1 |
Clinical feature | ||||||
Fever at diagnosis | 0.16 (0.01–1.1) | 0.06 | 1.28 (1.11–1.48) | 0.57 | 0.65 (0.11–3.74) | 0.64 |
GCS at diagnosis <8 pointsb | 0.68 (0.23–2.00) | 0.48 | 4.09 (0.83–20.14) | 0.71 | 0.94 (0.27–3.22) | 1 |
New focal neurological deficit at diagnosisb | 5.67 (0.56–57.23) | 0.16 | - | 0.08 | 3.94 (0.55–28.11) | 0.3 |
Complication (any) | NA | NA | 0.45 (0.11–1.92) | 0.33 | 2.78 (0.83–9.24) | 0.09 |
Hospital stay (mean) | 2 (–37 to 13) | 0.34 | 35 (–94 to 61) | 0.65 | 30.4 (12.7–48.05) | 0.05 |
Laboratory findings | ||||||
C-reactive protein ≥100 mg/L | 1.29 (0.50–3.31) | 0.60 | 1.00 (0.26–3.77) | 1 | 0.95 (0.30–2.99) | 0.93 |
CSF white cell ≥100 per μl | 1.10 (0.33–3.61) | 0.88 | 3.12 (0.36–27.50) | 0.42 | 0.79 (0.18–3.40) | 0.71 |
CSF glucose level <0.30 g/L | 0.99 (0.24–4.09) | 1 | 3.56 (0.66–19.11) | 0.15 | 1.31 (0.24–7.29) | 0.67 |
CSF protein level ≥1 g/L | 1.52 (0.55–4.17) | 0.42 | 0.51 (0.13–1.96) | 0.49 | 1.42 (0.38–5.31) | 0.75 |
Concomitant bacteremia | 1.15 (0.33–3.98) | 0.83 | 0.63 (0.07–5.88) | 1 | 3.43 (0.90–13.02) | 0.11 |
Negative CSF culture | 0.56 (0.20–1.58) | 0.27 | 0.78 (0.18–3.52) | 0.71 | 0.27 (0.08–0.89) | 0.05 |
Treatment | ||||||
Meropenem plus vancomycinc | 3.15 (1.08–9.22) | 0.03 | 0.96 (0.21–4.30) | 1 | 2.25 (0.63–8.06) | 0.31 |
Antibiotic treatment >14 daysd | 2.84 (0.91–8.86) | 0.07 | 1.48 (0.29–7.54) | 0.70 | 1.05 (0.19–5.74) | 1 |
Steroid therapy | 3.54 (0.97–12.96) | 0.05 | 4.34 (0.93–20.30) | 0.07 | 2.22 (0.56–8.82) | 0.26 |
Antiedematous therapy (including barbiturates) | - | 0.001 | 1.41 (0.24–8.16) | 0.65 | - | 0.19 |
CSF shunt | 1.42 (0.39–5.18) | 0.59 | 0.45 (0.05–4.04) | 0.67 | 0.79 (0.15–4.10) | 1 |
Neurology consult | 0.92 (0.34–2.48) | 0.87 | 5.25 (1.29–21.40) | 0.03 | 1.37 (0.42–4.44) | 0.60 |
Neurosurgery consult | 1.69 (0.45–6.40) | 0.44 | 1.58 (0.17–14.66) | 1 | 0.40 (0.10–1.61) | 0.23 |