Clinical features of bacterial meningitis in Italy: A multicenter prospective observational study

L. Lazzarini, M. Toti, P. Fabris, E. Conti, G. Magni, F. Mazzotta, F. De Lalla, N. Acone, G. Dell'Aquila, G. Pastore, R. Buongiorno, E. Francavilla, C. Granata, G. Maio, A. Sangiuolo, M. Andreoni, P. Bellissima, R. Russo, S. Tosto, A. StagnoC. Beltrami, S. Brighi, L. Guaglianone, F. Luciani, G. Carnevale, P. Viganò, T. Re, M. Fiore, V. Ciao, P. Padovani, F. Ghinelli, R. Bicocchi, F. Leoncini, M. Pozzi, G. Angarano, G. Scotto, E. Palumbo, C. Cancellieri, G. Pagano, M. Camera, G. Cassola, M. Toti, S. Giomi, A. Iannessi, A. Cellini, F. Soscia, G. Salone, P. Rovere, A. Scasso, A. Chiodera, G. Todaro, G. Orifici, M. Moroni, C. Negri, A. Cargnel, G. Gubertini, Z. Bisoffi, S. Marocco, M. Sapienza, P. Benenati, M. Colucci, G. Giordano, F. Baldelli, F. Di Candilo, F. Alberici, G. Ratti, T. Zauli, G. Foti, G. Magnani, G. Rossi, M. Arlotti, P. Ortolani, N. Petrosillo, V. Renda, G. Iaiani, P. Narciso, P. Ghirga, A. Paffetti, P. Mannozzi, V. Vullo, A. P. Massetti, M. Carretta, F. Viviani, R. F. Frongillo, M. Palumbo, P. Caramello, F. Gaiottino, P. Viale, M. Crapis, P. Grossi, [No Value] Dinatale, A. Poggio, V. Mondino

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

We carried out a prospective observational study on clinical features of bacterial meningitis. Between October 2002 and June 2005, 322 adult bacterial meningitis cases in 49 infectious disease wards in Italy (MENTORE study group) were enrolled in the study. 133 cases were due to Streptococcus pneumoniae, 44 to Neisseria meningitidis and 145 to other microorganisms. A high SAPS score and coma on admission, as well as need for mechanical ventilation, were more frequent in the pneumococcal meningitis group. Neurological impairment was present in 151 out of 311 patients, and was more frequent in pneumococcal meningitis. A single antibiotic was employed in only 90 of 315 cases; a combination of ceftriaxone and ampicillin was the most frequently administered treatment. Ceftriaxone was also the single most used drug. Adjunctive treatment with steroids was administered in 210 out of 303 patients for a median duration of 7 days. Median duration of fever was 4 days, and median hospital stay was 16 days; hospitalization was significantly longer in the pneumococcal meningitis group. At discharge, neurological impairment was still present in 59 (21%) of 277 patients. Twenty (6.9%) out of 289 patients died during hospitalization. Distribution of adverse outcome (death and neurological impairment) in patients treated with or without steroids and within different time zones between onset of symptoms and commencement of antibiotics was studied; a trend toward a worse prognosis was seen in patients treated more than 24 hours after onset of the disease. In our study, infectious disease clinicians made extensive use of steroids as adjuvant therapy for bacterial meningitis, even in absence of detailed national and local guidelines. Mortality seemed to be lower in comparison with the literature.

Original languageEnglish
Pages (from-to)478-487
Number of pages10
JournalJournal of Chemotherapy
Volume20
Issue number4
Publication statusPublished - Aug 2008

Fingerprint

Bacterial Meningitides
Italy
Observational Studies
Prospective Studies
Pneumococcal Meningitis
Ceftriaxone
Steroids
Communicable Diseases
Hospitalization
Anti-Bacterial Agents
Neisseria meningitidis
Ampicillin
Coma
Streptococcus pneumoniae
Artificial Respiration
Length of Stay
Fever
Therapeutics
Guidelines
Mortality

Keywords

  • Ampicillin
  • Ceftriaxone
  • Italy
  • Meningitis
  • Steroids

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases
  • Oncology
  • Pharmacology

Cite this

Lazzarini, L., Toti, M., Fabris, P., Conti, E., Magni, G., Mazzotta, F., ... Mondino, V. (2008). Clinical features of bacterial meningitis in Italy: A multicenter prospective observational study. Journal of Chemotherapy, 20(4), 478-487.

Clinical features of bacterial meningitis in Italy : A multicenter prospective observational study. / Lazzarini, L.; Toti, M.; Fabris, P.; Conti, E.; Magni, G.; Mazzotta, F.; De Lalla, F.; Acone, N.; Dell'Aquila, G.; Pastore, G.; Buongiorno, R.; Francavilla, E.; Granata, C.; Maio, G.; Sangiuolo, A.; Andreoni, M.; Bellissima, P.; Russo, R.; Tosto, S.; Stagno, A.; Beltrami, C.; Brighi, S.; Guaglianone, L.; Luciani, F.; Carnevale, G.; Viganò, P.; Re, T.; Fiore, M.; Ciao, V.; Padovani, P.; Ghinelli, F.; Bicocchi, R.; Leoncini, F.; Pozzi, M.; Angarano, G.; Scotto, G.; Palumbo, E.; Cancellieri, C.; Pagano, G.; Camera, M.; Cassola, G.; Toti, M.; Giomi, S.; Iannessi, A.; Cellini, A.; Soscia, F.; Salone, G.; Rovere, P.; Scasso, A.; Chiodera, A.; Todaro, G.; Orifici, G.; Moroni, M.; Negri, C.; Cargnel, A.; Gubertini, G.; Bisoffi, Z.; Marocco, S.; Sapienza, M.; Benenati, P.; Colucci, M.; Giordano, G.; Baldelli, F.; Di Candilo, F.; Alberici, F.; Ratti, G.; Zauli, T.; Foti, G.; Magnani, G.; Rossi, G.; Arlotti, M.; Ortolani, P.; Petrosillo, N.; Renda, V.; Iaiani, G.; Narciso, P.; Ghirga, P.; Paffetti, A.; Mannozzi, P.; Vullo, V.; Massetti, A. P.; Carretta, M.; Viviani, F.; Frongillo, R. F.; Palumbo, M.; Caramello, P.; Gaiottino, F.; Viale, P.; Crapis, M.; Grossi, P.; Dinatale, [No Value]; Poggio, A.; Mondino, V.

In: Journal of Chemotherapy, Vol. 20, No. 4, 08.2008, p. 478-487.

Research output: Contribution to journalArticle

Lazzarini, L, Toti, M, Fabris, P, Conti, E, Magni, G, Mazzotta, F, De Lalla, F, Acone, N, Dell'Aquila, G, Pastore, G, Buongiorno, R, Francavilla, E, Granata, C, Maio, G, Sangiuolo, A, Andreoni, M, Bellissima, P, Russo, R, Tosto, S, Stagno, A, Beltrami, C, Brighi, S, Guaglianone, L, Luciani, F, Carnevale, G, Viganò, P, Re, T, Fiore, M, Ciao, V, Padovani, P, Ghinelli, F, Bicocchi, R, Leoncini, F, Pozzi, M, Angarano, G, Scotto, G, Palumbo, E, Cancellieri, C, Pagano, G, Camera, M, Cassola, G, Toti, M, Giomi, S, Iannessi, A, Cellini, A, Soscia, F, Salone, G, Rovere, P, Scasso, A, Chiodera, A, Todaro, G, Orifici, G, Moroni, M, Negri, C, Cargnel, A, Gubertini, G, Bisoffi, Z, Marocco, S, Sapienza, M, Benenati, P, Colucci, M, Giordano, G, Baldelli, F, Di Candilo, F, Alberici, F, Ratti, G, Zauli, T, Foti, G, Magnani, G, Rossi, G, Arlotti, M, Ortolani, P, Petrosillo, N, Renda, V, Iaiani, G, Narciso, P, Ghirga, P, Paffetti, A, Mannozzi, P, Vullo, V, Massetti, AP, Carretta, M, Viviani, F, Frongillo, RF, Palumbo, M, Caramello, P, Gaiottino, F, Viale, P, Crapis, M, Grossi, P, Dinatale, NV, Poggio, A & Mondino, V 2008, 'Clinical features of bacterial meningitis in Italy: A multicenter prospective observational study', Journal of Chemotherapy, vol. 20, no. 4, pp. 478-487.
Lazzarini L, Toti M, Fabris P, Conti E, Magni G, Mazzotta F et al. Clinical features of bacterial meningitis in Italy: A multicenter prospective observational study. Journal of Chemotherapy. 2008 Aug;20(4):478-487.
Lazzarini, L. ; Toti, M. ; Fabris, P. ; Conti, E. ; Magni, G. ; Mazzotta, F. ; De Lalla, F. ; Acone, N. ; Dell'Aquila, G. ; Pastore, G. ; Buongiorno, R. ; Francavilla, E. ; Granata, C. ; Maio, G. ; Sangiuolo, A. ; Andreoni, M. ; Bellissima, P. ; Russo, R. ; Tosto, S. ; Stagno, A. ; Beltrami, C. ; Brighi, S. ; Guaglianone, L. ; Luciani, F. ; Carnevale, G. ; Viganò, P. ; Re, T. ; Fiore, M. ; Ciao, V. ; Padovani, P. ; Ghinelli, F. ; Bicocchi, R. ; Leoncini, F. ; Pozzi, M. ; Angarano, G. ; Scotto, G. ; Palumbo, E. ; Cancellieri, C. ; Pagano, G. ; Camera, M. ; Cassola, G. ; Toti, M. ; Giomi, S. ; Iannessi, A. ; Cellini, A. ; Soscia, F. ; Salone, G. ; Rovere, P. ; Scasso, A. ; Chiodera, A. ; Todaro, G. ; Orifici, G. ; Moroni, M. ; Negri, C. ; Cargnel, A. ; Gubertini, G. ; Bisoffi, Z. ; Marocco, S. ; Sapienza, M. ; Benenati, P. ; Colucci, M. ; Giordano, G. ; Baldelli, F. ; Di Candilo, F. ; Alberici, F. ; Ratti, G. ; Zauli, T. ; Foti, G. ; Magnani, G. ; Rossi, G. ; Arlotti, M. ; Ortolani, P. ; Petrosillo, N. ; Renda, V. ; Iaiani, G. ; Narciso, P. ; Ghirga, P. ; Paffetti, A. ; Mannozzi, P. ; Vullo, V. ; Massetti, A. P. ; Carretta, M. ; Viviani, F. ; Frongillo, R. F. ; Palumbo, M. ; Caramello, P. ; Gaiottino, F. ; Viale, P. ; Crapis, M. ; Grossi, P. ; Dinatale, [No Value] ; Poggio, A. ; Mondino, V. / Clinical features of bacterial meningitis in Italy : A multicenter prospective observational study. In: Journal of Chemotherapy. 2008 ; Vol. 20, No. 4. pp. 478-487.
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abstract = "We carried out a prospective observational study on clinical features of bacterial meningitis. Between October 2002 and June 2005, 322 adult bacterial meningitis cases in 49 infectious disease wards in Italy (MENTORE study group) were enrolled in the study. 133 cases were due to Streptococcus pneumoniae, 44 to Neisseria meningitidis and 145 to other microorganisms. A high SAPS score and coma on admission, as well as need for mechanical ventilation, were more frequent in the pneumococcal meningitis group. Neurological impairment was present in 151 out of 311 patients, and was more frequent in pneumococcal meningitis. A single antibiotic was employed in only 90 of 315 cases; a combination of ceftriaxone and ampicillin was the most frequently administered treatment. Ceftriaxone was also the single most used drug. Adjunctive treatment with steroids was administered in 210 out of 303 patients for a median duration of 7 days. Median duration of fever was 4 days, and median hospital stay was 16 days; hospitalization was significantly longer in the pneumococcal meningitis group. At discharge, neurological impairment was still present in 59 (21{\%}) of 277 patients. Twenty (6.9{\%}) out of 289 patients died during hospitalization. Distribution of adverse outcome (death and neurological impairment) in patients treated with or without steroids and within different time zones between onset of symptoms and commencement of antibiotics was studied; a trend toward a worse prognosis was seen in patients treated more than 24 hours after onset of the disease. In our study, infectious disease clinicians made extensive use of steroids as adjuvant therapy for bacterial meningitis, even in absence of detailed national and local guidelines. Mortality seemed to be lower in comparison with the literature.",
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TY - JOUR

T1 - Clinical features of bacterial meningitis in Italy

T2 - A multicenter prospective observational study

AU - Lazzarini, L.

AU - Toti, M.

AU - Fabris, P.

AU - Conti, E.

AU - Magni, G.

AU - Mazzotta, F.

AU - De Lalla, F.

AU - Acone, N.

AU - Dell'Aquila, G.

AU - Pastore, G.

AU - Buongiorno, R.

AU - Francavilla, E.

AU - Granata, C.

AU - Maio, G.

AU - Sangiuolo, A.

AU - Andreoni, M.

AU - Bellissima, P.

AU - Russo, R.

AU - Tosto, S.

AU - Stagno, A.

AU - Beltrami, C.

AU - Brighi, S.

AU - Guaglianone, L.

AU - Luciani, F.

AU - Carnevale, G.

AU - Viganò, P.

AU - Re, T.

AU - Fiore, M.

AU - Ciao, V.

AU - Padovani, P.

AU - Ghinelli, F.

AU - Bicocchi, R.

AU - Leoncini, F.

AU - Pozzi, M.

AU - Angarano, G.

AU - Scotto, G.

AU - Palumbo, E.

AU - Cancellieri, C.

AU - Pagano, G.

AU - Camera, M.

AU - Cassola, G.

AU - Toti, M.

AU - Giomi, S.

AU - Iannessi, A.

AU - Cellini, A.

AU - Soscia, F.

AU - Salone, G.

AU - Rovere, P.

AU - Scasso, A.

AU - Chiodera, A.

AU - Todaro, G.

AU - Orifici, G.

AU - Moroni, M.

AU - Negri, C.

AU - Cargnel, A.

AU - Gubertini, G.

AU - Bisoffi, Z.

AU - Marocco, S.

AU - Sapienza, M.

AU - Benenati, P.

AU - Colucci, M.

AU - Giordano, G.

AU - Baldelli, F.

AU - Di Candilo, F.

AU - Alberici, F.

AU - Ratti, G.

AU - Zauli, T.

AU - Foti, G.

AU - Magnani, G.

AU - Rossi, G.

AU - Arlotti, M.

AU - Ortolani, P.

AU - Petrosillo, N.

AU - Renda, V.

AU - Iaiani, G.

AU - Narciso, P.

AU - Ghirga, P.

AU - Paffetti, A.

AU - Mannozzi, P.

AU - Vullo, V.

AU - Massetti, A. P.

AU - Carretta, M.

AU - Viviani, F.

AU - Frongillo, R. F.

AU - Palumbo, M.

AU - Caramello, P.

AU - Gaiottino, F.

AU - Viale, P.

AU - Crapis, M.

AU - Grossi, P.

AU - Dinatale, [No Value]

AU - Poggio, A.

AU - Mondino, V.

PY - 2008/8

Y1 - 2008/8

N2 - We carried out a prospective observational study on clinical features of bacterial meningitis. Between October 2002 and June 2005, 322 adult bacterial meningitis cases in 49 infectious disease wards in Italy (MENTORE study group) were enrolled in the study. 133 cases were due to Streptococcus pneumoniae, 44 to Neisseria meningitidis and 145 to other microorganisms. A high SAPS score and coma on admission, as well as need for mechanical ventilation, were more frequent in the pneumococcal meningitis group. Neurological impairment was present in 151 out of 311 patients, and was more frequent in pneumococcal meningitis. A single antibiotic was employed in only 90 of 315 cases; a combination of ceftriaxone and ampicillin was the most frequently administered treatment. Ceftriaxone was also the single most used drug. Adjunctive treatment with steroids was administered in 210 out of 303 patients for a median duration of 7 days. Median duration of fever was 4 days, and median hospital stay was 16 days; hospitalization was significantly longer in the pneumococcal meningitis group. At discharge, neurological impairment was still present in 59 (21%) of 277 patients. Twenty (6.9%) out of 289 patients died during hospitalization. Distribution of adverse outcome (death and neurological impairment) in patients treated with or without steroids and within different time zones between onset of symptoms and commencement of antibiotics was studied; a trend toward a worse prognosis was seen in patients treated more than 24 hours after onset of the disease. In our study, infectious disease clinicians made extensive use of steroids as adjuvant therapy for bacterial meningitis, even in absence of detailed national and local guidelines. Mortality seemed to be lower in comparison with the literature.

AB - We carried out a prospective observational study on clinical features of bacterial meningitis. Between October 2002 and June 2005, 322 adult bacterial meningitis cases in 49 infectious disease wards in Italy (MENTORE study group) were enrolled in the study. 133 cases were due to Streptococcus pneumoniae, 44 to Neisseria meningitidis and 145 to other microorganisms. A high SAPS score and coma on admission, as well as need for mechanical ventilation, were more frequent in the pneumococcal meningitis group. Neurological impairment was present in 151 out of 311 patients, and was more frequent in pneumococcal meningitis. A single antibiotic was employed in only 90 of 315 cases; a combination of ceftriaxone and ampicillin was the most frequently administered treatment. Ceftriaxone was also the single most used drug. Adjunctive treatment with steroids was administered in 210 out of 303 patients for a median duration of 7 days. Median duration of fever was 4 days, and median hospital stay was 16 days; hospitalization was significantly longer in the pneumococcal meningitis group. At discharge, neurological impairment was still present in 59 (21%) of 277 patients. Twenty (6.9%) out of 289 patients died during hospitalization. Distribution of adverse outcome (death and neurological impairment) in patients treated with or without steroids and within different time zones between onset of symptoms and commencement of antibiotics was studied; a trend toward a worse prognosis was seen in patients treated more than 24 hours after onset of the disease. In our study, infectious disease clinicians made extensive use of steroids as adjuvant therapy for bacterial meningitis, even in absence of detailed national and local guidelines. Mortality seemed to be lower in comparison with the literature.

KW - Ampicillin

KW - Ceftriaxone

KW - Italy

KW - Meningitis

KW - Steroids

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C2 - 18676229

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VL - 20

SP - 478

EP - 487

JO - Journal of Chemotherapy

JF - Journal of Chemotherapy

SN - 1120-009X

IS - 4

ER -