[Sequelae and death following pneumococcal meningitis].

INTRODUCTION

The aim was to evaluate prognostic factors and outcome parameters related to otogenic pneumococcal meningitis (OPM).

MATERIALS AND

METHODS

Retrospective analysis of patients with OPM in Aarhus County from 1994 to 2003.

RESULTS

Seventy patients were included, corresponding to an annual incidence of 11.7/mill. The mean age was 36.6 years (range: four days - 80 years) and the mean duration from debut of acute otitis media (AOM) to admission was three days. Twenty three percent had received antibiotics prior to admission. The most common symptoms were fever and affected consciousness. The mortality was 11%, and 40% of the surviving population developed permanent sequelae, of which 88% suffered loss of hearing. Sixty one percent was not evaluated audiologically after hospitalization.

CONCLUSION

Pre-admission antibiotics were associated with a decreased risk of death and sequelae. Affected consciousness was a significant prognostic factor. The mortality rate was four times higher among adults than among children. Mastoidectomy was performed in 56% of adults without any significant influence on the outcome. Based on the presented results it appears relevant to treat cases of AOM, especially in adults with early antimicrobials due to their higher relative risk of developing OPM and the related risk of a poor outcome. In addition, maintenance of the previously established treatment regimen in OPM followed by audiological control is recommended.