BACTERIAL-MENINGITIS IN ADULTS IN THE INT ENSIVE-CARE UNIT - CLINICALANALYSIS AND PROGNOSIS FACTORS

Objectives: Bacterial meningitis frequently leads to hospitalization i n the intensive care unit. Despite progress in antibiotics, prognosis remains poor. Methods: We analyzed the clinical manifestations and com plications which occurred in 41 patients admitted to the intensive car e unit for bacterial meningitis, A case-control survey was used to det ermine prognosis factors. Results: All patients required ventilatory a ssistance and 83% were in a state of coma at admission, Causal germs i solated were: Pneumococci 34%, Listeria 22%, Staphylococcus aureus 17% , and Gram-positive bacilli 12%. Overall mortality was 56%. The main p rognosis factors after univariate analysis were age, delay to treatmen t, presence of septic shock, bacteriemia at admission, low cell count in first lumbar tap, high urea level and low protein level, After mult ivariate analysis, the following risk factors were retained: low numbe r of leukocytes at first lumbar tap and high urea level. Conclusion: T he gravity of bacterial meningitis in the intensive care unit appears to be related to the patient's overwhelmed defense system and especial ly to hemodynamic disorders with acute renal failure and capillary hyp erpermeability leading to insufficient cerebral perfusion.