Community-acquired bacterial meningitis (CABM) is a rare but dangerous infectious disease with an incidence in 2006 in adults estimated at 2.23/100,000 inhabitants per year in developed countries and an associated overall mortality of 20%. The various functional, physical, psychological and social attacks of this pathology can generate real handicaps or deterioration of the mental and social quality of life of people. Neurological sequelae are reported in almost 30% of surviving adult patients and can go up to 50% with pneumococcal meningitis, but available studies however focused on a single aspect of neurological sequelae, either functional or physical disability. We analysed the COMBAT cohort to better understand the determinants of long-term neurological outcome in patients with community-acquired bacterial meningitis.

In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM in 69 French participating centers were enrolled and followed up for 12 months. Neurological sequelae at 12 months were evaluated using a combination of two scores, the Glasgow Outcome Scale, which measures the functional disability, and the modified Rankin Disability Scale, which focuses on physical disability. Factors associated with neurological sequelae were identified by multivariate logistic regression.

Among 281 patients included in the analysis, 84 (29.9%) patients exhibited neurological sequelae at 12 months, including 79 (28.1%) with functional disability and 51 (18.1%) with physical disability. Overall, 6 patients (2.1%) died during the follow up. The most common pathogen identified for meningitis was the Streptococcus pneumoniae (131/272, 48.2%) and 77/268 patients (28.7%) had physical disability at hospital discharge. Factors independently associated with neurological sequelae at 12 months were a pneumococcal meningitis (adjusted OR=2.8; 95% confidence interval (CI) [1.3; 6.7]), the presence of physical disability at hospital discharge (aOR=2.3; 95%CI [1.2; 4.4]) and the presence of behavioral disorders at hospital discharge (aOR=5.9; 95%CI [1.6; 28.4]). Dexamethasone use was not significantly associated with neurological sequelae (OR=0.2; 95%CI [<0.1;1.3]).

Neurological sequelae are frequently reported 12 months after CABM. Detailed examination before discharge should focus on the neurological status to improve the follow up following CABM in adult patients.