Meningitis and encephalitis can be caused by various infectious pathogens but large epidemiological studies evaluating etiologies, management decisions and outcomes in the United States (US) are lacking.
All adult patients (age ≥18 years) with a discharge or admitting diagnosis of meningitis or encephalitis by ICD-9 codes available in the US Premier Healthcare Database from 2011-2014 were analyzed.
A total of 26,429 patients with meningitis or encephalitis were identified. The median age was 43 years; 53% were female. The most common etiology was viral (16152, 61%); followed by unknown (4944, 18.7%), bacterial (3692, 13.9%), non-infectious (921, 3.4%), and fungal (720, 2.7%). Empirical antibiotics, antivirals and antifungals were administered in 85.8%, 53.4%, and 7.8%, respectively and varied by etiologies. Adjunctive steroids were utilized in 25.1% of all patients and in 44.7% of patients with bacterial meningitis. The median length of hospital stay was 4 days; with the longest duration in those with fungal (13 days), arboviral (10 days ), and bacterial meningitis (7 days) . Overall mortality was 2.9% and was higher in those with bacterial (8.2%), fungal (8.2%), or arboviral (8.9%) etiologies. Readmission rate at 30 days was 3.2%; patients with arbovirus (12.7%), bacterial (6.7%) and fungal (5.4%) etiologies had higher rates.
Meningitis and encephalitis was most commonly caused by viruses; management decisions and clinical outcomes vary by etiology. Adjunctive steroids are being underutilized in bacterial meningitis.
J. Chung, Premier access: Consultant , contracted by Biomerieux
C. Ginocchio, BioFire Diagnostics: Employee , Salary
J. M. Balada-Llasat, Biomerieux: Consultant , Consulting fee
L. Banks, Biofire diagnostics: Employee , Salary
L. Zimmer, Biomerieux: Employee , Salary
S. Bozzette, Biomerieux: Employee , Salary