Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Community-acquired bacterial meningitis remains associated with high mortality and neurological disability in critically ill adults. Contemporary data on outcomes in mechanically ventilated patients and on the role of invasive intracranial pressure monitoring are limited. We aimed to describe 90-day outcomes, identify predictors of unfavorable neurological outcome, and evaluate the association between invasive intracranial pressure monitoring and prognosis in mechanically ventilated adults with community-acquired bacterial meningitis. Methods: Retrospective multicenter cohort study (2012-2023) across 26 French ICUs. The primary endpoint was unfavorable functional outcome at day 90 (modified Rankin Scale score 3-6), assessed using multivariable mixed-effects regression and propensity score-based overlap weighting. Findings: Among 704 included patients (median age, 66 years [IQR, 48-70 years]; 421 men [59.8%]), 354 (50.3%) had an unfavorable outcome at day 90, including 220 (31.3%) who died. Independent predictors of unfavorable outcome included older age, septic shock, acute kidney injury, coagulation disorders, lower motor score on the Glasgow Coma Scale, pupillary abnormalities, and abnormal brain imaging findings at presentation. Appropriate initial antimicrobial therapy, along with adjunctive dexamethasone, was associated with improved outcomes. Invasive intracranial pressure monitoring was performed in 84/704 patients (11.9%) and was not associated with improved functional outcome in the overall cohort (odds ratio, 0.97; 95% CI, 0.48-1.96) or in prespecified subgroups. Interpretation: In this large real-world cohort, 90-day mortality and disability remain high and are largely driven by initial neurological and systemic severity. Invasive intracranial pressure monitoring was not associated with improved outcomes, and no clear benefit was identified in this observational analysis. Funding: None.
Authors: Cindy Poirier, Nicolas Terzi, Nicolas Roesch, Laurent Argaud, Sarah Jouin, Marc Le Pape, Jean-Rémi Lavillegrand, Hervé Hyvernat, Romain Tymen, Pierrick Lafarge, David Bougon, Pierrick Bauduin, Jérémie Mallet, Julien Jabot, Guillaume Navarro, François Arrivé, Juliette Bernier, Michel Badet, Maxens Decavele, Anaïs Curtiaud, Eddine Bendiab, Baptiste Balanca, Benoit Champigneulle, Sami Hraiech, Loïc Le Guennec, Elodie Fournier, Emmanuel Canet, Romain Sonneville, Guillaume Dumas, François Beloncle, François Barbier, Nicolas de Prost, Mathieu Jozwiak, Cécile Aubron, Frédéric Pène, Damien Du Cheyron, Tai Pham, Phan Hoang, Florian Contard, Clément Brault, Rémi Coudroy, Hafid Ait Oufella, Ferhat Meziani, Kada Klouche
Institutions: Inserm, Centre Hospitalier Universitaire de Grenoble, Hypoxie et Physiopathologies cardiovasculaires et respiratoires, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Centre Hospitalier Universitaire de Nantes, Université de Nantes, Nantes Université, Lyon 1 Université, Hospices Civils de Lyon, Hôpital Edouard Herriot, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Centre hospitalier universitaire d'Orléans, Centre Hospitalier Universitaire Henri-Mondor, Hôpitaux Universitaires Henri-Mondor, Université Côte d'Azur, Hôpital l'Archet, Université de Bretagne Occidentale, Centre Hospitalier Régional Universitaire de Brest, Université de Bretagne Occidentale, Université Paris Cité, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Centre Hospitalier Annecy Genevois, Centre Hospitalier Universitaire de Caen Normandie, Université de Caen Normandie, Université Paris-Saclay, Bicêtre Hospital, University of Reunion Island, Centre Hospitalier Universitaire de La Réunion, Centre Hospitalier Universitaire Amiens-Picardie, Université de Picardie Jules Verne, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, Sorbonne Université, Hôpital Saint-Antoine, Centre Hospitalier Métropole Savoie, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Strasbourg, Université de Strasbourg, Hôpital Lapeyronie, Université Montpellier 1, Hôpital Pierre Wertheimer, Université Grenoble Alpes, Aix-Marseille Université, Hôpital Nord, Pitié-Salpêtrière Hospital, Hôpital Bichat-Claude-Bernard, Infection, Anti-microbiens, Modélisation, Evolution
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,930
OpenAlex ID: W7167526317