Elderly adults see worse bacterial meningitis outcomes

Community-acquired bacterial meningitis in adults aged ≥80 years leads to high rates of mortality and unfavourable outcomes, reports a recent study.

The study included 2,140 cases of community-acquired bacterial meningitis, of which 149 occurred in patients aged ≥80. Thirty-six (24 percent) of the elderly patients were immunocompromised, mostly due to diabetes mellitus. Otitis or sinusitis and pneumonia were other common predisposing factors.

Complications were common among patients ≥80 years, occurring in 91 of 145 (63 percent) elderly participants with assessable data. The same was true for systemic complications (51 percent; n=74 of 145), such as pneumonia (27 percent; n=34), respiratory failure (40 percent; n=56), and circulatory shock (18 percent; n=24).

Neurological complications were likewise common in elderly patients, with an incidence rate of 33 percent. This included seizures (23 percent), focal neurologic deficits (16 percent), and cerebrovascular accidents (10 percent).

Compared with younger counterparts, elderly patients were significantly more likely to show systemic complications (51 percent vs 33 percent; p<0.001) and seizures (23 percent vs 13 percent; p=0.001).

Similarly, case fatality rate was significantly higher in elderly vs younger bacterial meningitis patients (50 percent vs 15 percent; p<0.001). Deaths were mostly attributed to systemic complications such as cardiorespiratory failure and septic shock. Care withdrawal due to poor neurological prognosis was also a common cause of death.

“Hospital care of patients aged 80 years and older with bacterial meningitis is different compared to younger patients. As atypical pathogens occur more often, these [findings] should be considered when choosing empirical antibiotic therapy,” the researchers said. “Furthermore, this paper helps [in] recognizing the disease and its complications in this patient category.”