Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis

We analysed the clinical course of 30 adult patients with Klebsiella pneumo niae meningitis, 18 community-acquired and 12 hospital-acquired, to assess whether the timing of appropriate antimicrobial therapy had a major effect on prognosis. Of the 30 patients, 29 received appropriate antibiotics. The time from initial symptoms to the start of appropriate therapy, antibiotic resistance of K. pneumoniae isolates, underlying disease severity, diabetes mellitus, age, gender,and acquisition settings were all not significantly correlated with outcome. However, a Glasgow coma scale (GCS) score of 7 poi nts or less at the start of appropriate antimicrobial therapy was a valid p redictor of death or a permanent vegetative state (sensitivity 82%, specifi city 93%, p=0.005), even after adjusting for the effect of confounding vari ables by logistic regression. Timing of appropriate antimicrobial therapy, as defined by consciousness level but not by symptom duration, is a major d eterminant of survival and neurological outcome for patients with K. pneumo niae meningitis, and the first dose of an appropriate antibiotic should be administrated before their consciousness deteriorates to a GCS score of 7 p oints or less.