Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study
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/).
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BibTeX
@article{poirier2026outcomes,
title = {{Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study}},
author = {Cindy Poirier and Nicolas Terzi and Nicolas Roesch and Laurent Argaud and Sarah Jouin and Marc Le Pape and Jean-Rémi Lavillegrand and Hervé Hyvernat and Romain Tymen and Pierrick Lafarge and David Bougon and Pierrick Bauduin and Jérémie Mallet and Julien Jabot and Guillaume Navarro and François Arrivé and Juliette Bernier and Michel Badet and Maxens Decavèle and Anaïs Curtiaud and Eddine Bendiab and Baptiste Balanca and Benoît Champigneulle and Sami Hraiech and Loïc Le Guennec and Elodie Fournier and Emmanuel Canet and Romain Sonneville and Guillaume Dumas},
journal = {The Lancet Regional Health - Europe},
year = {2026},
month = jul,
doi = {10.1016/j.lanepe.2026.101767},
url = {https://hal.science/hal-05728783v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Outcomes, prognostic factors, and the role of intracranial pressure monitoring in severe community-acquired bacterial meningitis: a multicenter retrospective cohort study
AU - Cindy Poirier
AU - Nicolas Terzi
AU - Nicolas Roesch
AU - Laurent Argaud
AU - Sarah Jouin
AU - Marc Le Pape
AU - Jean-Rémi Lavillegrand
AU - Hervé Hyvernat
AU - Romain Tymen
AU - Pierrick Lafarge
AU - David Bougon
AU - Pierrick Bauduin
AU - Jérémie Mallet
AU - Julien Jabot
AU - Guillaume Navarro
AU - François Arrivé
AU - Juliette Bernier
AU - Michel Badet
AU - Maxens Decavèle
AU - Anaïs Curtiaud
AU - Eddine Bendiab
AU - Baptiste Balanca
AU - Benoît Champigneulle
AU - Sami Hraiech
AU - Loïc Le Guennec
AU - Elodie Fournier
AU - Emmanuel Canet
AU - Romain Sonneville
AU - Guillaume Dumas
PY - 2026
DA - 2026/07/06
JO - The Lancet Regional Health - Europe
DO - 10.1016/j.lanepe.2026.101767
UR - https://hal.science/hal-05728783v1
AB - 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/).
SN - 2666-7762
ER -