Q J Med 2000; 93: 45-53
© 2000 Association of Physicians
Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis
1 From the Departments of Internal Medicine and 2 Laboratory Medicine, National Taiwan University Hospital, and 3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Received 4 August 1999
Dr S.-C. Chang, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. e-mail: sc4030{at}ha.mc.ntu.edu.tw
We analysed the clinical course of 30 adult patients with Klebsiella pneumoniae meningitis, 18 community-acquired and 12 hospital-acquired, to assess whether the timing of appropriate antimicrobial therapy had a major effect on prognosis. Of the 30 patients, 29 received appropriate antibiotics. The time from initial symptoms to the start of appropriate therapy, antibiotic resistance of K. pneumoniae isolates, underlying disease severity, diabetes mellitus, age, gender, and acquisition settings were all not significantly correlated with outcome. However, a Glasgow coma scale (GCS) score of 7 points or less at the start of appropriate antimicrobial therapy was a valid predictor of death or a permanent vegetative state (sensitivity 82%, specificity 93%, p=0.005), even after adjusting for the effect of confounding variables by logistic regression. Timing of appropriate antimicrobial therapy, as defined by consciousness level but not by symptom duration, is a major determinant of survival and neurological outcome for patients with K. pneumoniae meningitis, and the first dose of an appropriate antibiotic should be administrated before their consciousness deteriorates to a GCS score of 7 points or less.
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