Meningitis Identified in Critically Ill Patients with Severe Pneumococcal Pneumonia in ICU

A recent study conducted by a dedicated team of researchers from the Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and affiliated with Université de Paris Cité, Paris, and Université Côte d’Azur, Nice, France, has shed new light on the development of meningitis in patients suffering from severe community-acquired pneumococcal pneumonia admitted to the intensive care unit (ICU).

The research, spanning fifteen years from January 2006 to December 2020, focused on identifying and analyzing the characteristics and outcomes of patients with severe pneumococcal pneumonia who developed meningitis during their ICU stay. The presence of meningitis was identified using criteria including pleocytosis greater than 5 cells/mm3 or a positive culture of cerebrospinal fluid for Streptococcus pneumoniae from lumbar puncture.

The study included a total of 262 patients, primarily male, and many suffering from chronic respiratory disease or immunocompromised. Notably, only a fraction of the patients were vaccinated against S. pneumoniae. A subset of patients underwent lumbar puncture with a delay averaging slightly over 10 hours post ICU admission, predominantly after the initiation of pneumococcal antibiotherapy.

Findings revealed that 14 patients, translating to 16% of those who underwent lumbar puncture and 5% of the entire group, developed meningitis. These patients were more likely to have preexisting conditions such as human immunodeficiency virus and exhibited neurological deficits and bacteremia more frequently than their non-meningitis counterparts.

Although the ICU and 90-day post-admission mortality rates were similar for patients with and without meningitis, those with meningitis presented a significantly higher rate of neurological disorders at the time of ICU discharge. Importantly, the meningitis group did not differ significantly in other outcomes at ICU discharge or at 30- and 90-day benchmarks.

This research underscores the diagnostic relevance of meningitis in patients with severe pneumococcal pneumonia, particularly those with bacteremia. It has highlighted the necessity for increased vigilance for neurological disorders in these patients upon ICU discharge.

The study team, comprising Jaubert Paul P, Charpentier Julien J, Benghanem Sarah S, Cariou Alain A, Pène Frédéric F, Mira Jean-Paul JP, and Jozwiak Mathieu M, recommend further investigations to validate these findings and potentially revise current guidelines that do not systematically suggest lumbar puncture for this patient demographic, despite the severity of their condition and associated risk factors.

The research is a part of an ongoing effort to improve patient outcomes and the management of severe infections and has most likely been peer-reviewed and published for the medical community’s access.

The work of these dedicated professionals is crucial in the battle against infectious diseases and their serious complications in critically ill patients. The new insights provided by the study have the potential to influence practice guidelines and improve care for those affected by severe forms of pneumococcal diseases, such as pneumonia and meningitis.

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