Department of Neurology, Center of Infection and Immunity Amsterdam, The Netherlands.
Neurology. 2012 Oct 9;79(15):1563-9. doi: 10.1212/WNL.0b013e31826e2684. Epub 2012 Sep 12.
We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis.
We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone.
Dexamethasone was administered in 43 of 258 (17%) patients in the 1998-2002 cohort and in 86 of 96 (90%) patients in the 2006-2011 cohort (p < 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p < 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 [12%] vs 30 of 258 [12%]; p = 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 [3%] vs 19 of 237 [8%]; p = 0.10) and death (4 of 100 [4%] vs 19 of 258 [7%]; p = 0.24) were lower in the 2006-2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 [12%] vs 5 of 96 [5%], p = 0.046). Dexamethasone was not associated with adverse events.
Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone.
This study provides Class III evidence that adjuvant dexamethasone in adults with meningococcal meningitis does not increase negative outcomes such as deafness, death, or negative Glasgow Outcome Scale measures.
我们评估了辅助使用地塞米松治疗脑膜炎奈瑟菌脑膜炎的效果和实施情况。
我们比较了两项荷兰全国性前瞻性社区获得性脑膜炎奈瑟菌脑膜炎队列研究。1998 年至 2002 年期间，共纳入 258 例经脑脊液培养确诊为脑膜炎的患者，当时常规使用地塞米松治疗，2006 年 3 月至 2011 年 1 月期间纳入 100 例患者，此时地塞米松已被纳入指南推荐。
1998-2002 年队列中有 43 例（17%）患者使用了地塞米松，2006-2011 年队列中有 86 例（90%）患者使用了地塞米松（p<0.001）；在 258 例患者中，有 12 例（5%）在使用首剂抗生素前或同时使用了地塞米松，而在 96 例患者中，有 85 例（89%）患者使用了地塞米松（p<0.001）。两组的不良预后发生率相似（100 例中有 12 例[12%] vs 258 例中有 30 例[12%]；p=0.67），脑膜炎奈瑟菌血清群校正后也相似。2006-2011 年队列中听力损失（96 例中有 3 例[3%] vs 237 例中有 19 例[8%]；p=0.10）和死亡（100 例中有 4 例[4%] vs 258 例中有 19 例[7%]；p=0.24）的发生率较低，但未达到统计学意义。地塞米松治疗组关节炎发生率较低（258 例中有 32 例[12%] vs 96 例中有 5 例[5%]；p=0.046）。地塞米松未引起不良事件。
地塞米松广泛用于治疗脑膜炎奈瑟菌脑膜炎，且未增加耳聋、死亡或不良格拉斯哥结局量表评分等不良结局的风险。关节炎的发生率在使用地塞米松后有所下降。
本研究提供了 III 级证据，表明地塞米松辅助治疗成人脑膜炎奈瑟菌脑膜炎不会增加耳聋、死亡或负面格拉斯哥结局量表评分等不良结局的风险。
