Epidemiology of Meningitis and Encephalitis in the United States from 2011-2014.
Clin Infect Dis. 2017 Apr 17;:
Authors: Hasbun R, Rosenthal N, Balada-Llasat JM, Chung J, Duff S, Bozzette S, Zimmer L, Ginocchio CC
Abstract
Background: Large epidemiological studies evaluating the etiologies, management decisions and outcomes of adults with meningitis and encephalitis in the United States (US) are lacking.
Methods: Adult patients (≥18 years) with meningitis or encephalitis by ICD-9 codes available in the Premier Healthcare Database during 2011-2014 were analyzed.
Results: A total of 26,429 patients with meningitis or encephalitis were identified. The median age was 43 years; 53% were female. The most common etiology was enterovirus (13463, 50.9%); followed by unknown (4944, 18.7%), bacterial meningitis (3692, 13.9%), Herpes Simplex Virus (2184, 8.3%), non-infectious (921, 3.4%), fungal (720, 2.7%) arboviruses (291, 1.1%), and other viruses (214, 0.8%). Empirical antibiotics, antivirals and antifungals were administered in 85.8%, 53.4%, and 7.8%, respectively and varied by etiologies. Adjunctive steroids were utilized in 15.9% of all patients and in 39.33% of patients with pneumococcal meningitis with an associated decrease in mortality (6.67% vs. 12.5%, P=0.0245). The median length of stay was 4 days; with the longest duration in those with fungal (13), arboviral (10), and bacterial meningitis (7). Overall inpatient mortality was 2.9% and was higher in those with bacterial (8.2%), fungal (8.2%), or arboviral (8.9%) disease. Overall readmission rate at 30 days was 3.2%; patients with arboviral (12.7%), bacterial (6.7%) and fungal (5.4%) etiologies had higher rates.
Conclusion: Viruses are the most common cause of meningitis and encephalitis in the US and are treated with antibiotic therapy in the majority of cases. Adjunctive steroids are underutilized in pneumococcal meningitis where it has shown to decrease mortality.
PMID: 28419350 [PubMed - as supplied by publisher]