{
  "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. Copyright (c) 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 29,
  "authors": [
    {
      "name": "Cindy Poirier"
    },
    {
      "name": "Nicolas Terzi"
    },
    {
      "name": "Nicolas Roesch"
    },
    {
      "name": "Laurent Argaud"
    },
    {
      "name": "Sarah Jouin"
    },
    {
      "name": "Marc Le Pape"
    },
    {
      "name": "Jean-Rémi Lavillegrand"
    },
    {
      "name": "Hervé Hyvernat"
    },
    {
      "name": "Romain Tymen"
    },
    {
      "name": "Pierrick Lafarge"
    },
    {
      "name": "David Bougon"
    },
    {
      "name": "Pierrick Bauduin"
    },
    {
      "name": "Jérémie Mallet"
    },
    {
      "name": "Julien Jabot"
    },
    {
      "name": "Guillaume Navarro"
    },
    {
      "name": "François Arrivé"
    },
    {
      "name": "Juliette Bernier"
    },
    {
      "name": "Michel Badet"
    },
    {
      "name": "Maxens Decavèle"
    },
    {
      "name": "Anaïs Curtiaud"
    },
    {
      "name": "Eddine Bendiab"
    },
    {
      "name": "Baptiste Balanca"
    },
    {
      "name": "Benoît Champigneulle"
    },
    {
      "name": "Sami Hraiech"
    },
    {
      "name": "Loïc Le Guennec"
    },
    {
      "name": "Elodie Fournier"
    },
    {
      "name": "Emmanuel Canet"
    },
    {
      "name": "Romain Sonneville"
    },
    {
      "name": "Guillaume Dumas"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4h3065qjk4xp9.bib",
  "cited_by": 0,
  "doi": "10.1016/j.lanepe.2026.101767",
  "fulltext_url": null,
  "id": "4h3065qjk4xp9",
  "issns": [
    "2666-7762"
  ],
  "landing_url": "https://hal.science/hal-05728783v1",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.mhep"
    ],
    [
      "openalex",
      "2404|Bacterial Infections and Vaccines"
    ]
  ],
  "openalex": "W7167526317",
  "pdf_url": "https://hal.science/hal-05728783/document",
  "pmcid": null,
  "pmid": "42436935",
  "published": "2026-07-06",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/4h3065qjk4xp9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:29Z",
      "native_id": "hal-05728783",
      "source": "hal",
      "url": "https://hal.science/hal-05728783v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2404|Bacterial Infections and Vaccines",
      "subfield": "microbiology"
    }
  ],
  "title": "Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study",
  "title_text": "Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:29Z",
  "url": "https://research.draconitic.com/paper/4h3065qjk4xp9",
  "venue": "The Lancet Regional Health - Europe",
  "versions": []
}