Background Bacterial meningitis is associated with significant morbidity and mortality despite
Background Bacterial meningitis is associated with significant morbidity and mortality despite advances in medical care. done in 56?%; only 19?% had CSF findings compatible with bacterial meningitis, and only 3?% had proven etiology). The overall in hospital mortality rate was 20.2?%. Impaired consciousness, aspiration pneumonia, and cranial nerve palsy at admission were independently associated with increased mortality. Adjuvant dexamethasone, which was used in 50.4?% of patients, was associated with increased in-hospital mortality (AOR?=?3.38; Mouse monoclonal to Glucose-6-phosphate isomerase 95?% CI 1.87C6.12, C Cases with acute onset (7?days) of fever (axillary temperature of 38.0?C) PLUS any of: neck stiffness and altered consciousness PLUS no other alternative diagnosis PLUS no or incomplete CSF Cryptotanshinone supplier analysis. C Cases with clinical signs as described for suspected unproven ABM PLUS CSF examination showing at least one of the following three C (1) turbid appearance (2) pleocytosis (>100 white cells/mm3) (3) pleocytosis (10C100 white cells/mm3) AND either an elevated protein (>100?mg/dl) or decreased CSF to serum glucose ratio (<40?%). C Cases with detected microorganisms by culture, gram stain or agglutination test from CSF specimen. (bacterial meningitis less likely) C Cases not fulfilling any of the above criteria and/or those with evidences suggesting other diagnoses. Data collection procedure Patients treated as cases of ABM were identified using the data from inpatient registration books of medical wards at each hospital. Their medical records were then retrieved from the archives to be reviewed according to a structured questionnaire prepared for the study (Additional file 1). The information gathered included socio-demographic profiles, clinical conditions at presentation, type of antibiotic treatment, adjunctive dexamethasone treatment, clinical course in the hospital, and discharge conditions (death and neurologic sequelae). Glasgow Outcome Scale (GOS) was interpreted from the discharge note (see below). Definitions of outcome variables (FND) C refers to (1) unilateral extremity weakness [monoparesis or hemiparesis] (2) unilateral hypaesthesia (3) localized cranial nerve palsies (III, IV and VII). C was the interpretation of treating physicians documentation of the patient status at discharge. 1?=?if death was documented; 2?=?if patient was in coma or unresponsiveness at leaving hospital; 3?=?if document included some improvement and any of hemiplegia, paraparesis, or major disability; 4?=?if document included improved with minor sequelae such as facial palsy or decreased hearing capacity; 5?=?if document included full recovery or discharge with complete improvement. C was stated using Glasgow Coma Scale (GCS) which ranges from score of 3 to 15. Patients with score of 15 were considered as fully conscious; 9C14 as and as for scores between 3 and 8. Data processing, analysis and interpretation The data was checked for completeness and consistency. It was then entered to EpiData version 3. 1 and was later transferred to SPSS? (IBM Corporation) version 20 for analysis. Bivariable analysis was done to identify association between dependent and independent variables. All independent variables with C by dichotomizing GOS into favorable (GOS?=?5) and unfavorable (GOS =1 to 4) outcome, we found that admission GCS (AOR?=?0.77; 95?% CI?=?0.66C0.89) and dexamethasone treatment (AOR?=?4.46; 95?% CI 1.98C10.08) were independently associated with unfavorable outcome. Note that GCS had reverse association with poor outcome; every increment from lowest of 3 to 15 resulted in improvement of outcome by 23?%. Fifty-two (12.2?%) of patients were additionally treated with presumptive diagnosis of tuberculous meningitis (TBM). These groups of patients Cryptotanshinone supplier had unfavourable outcome at discharge as compared to other groups (AOR?=?2.78; 95?% CI 1.06C7.30). C Admission Glasgow coma scale, presence of pneumonia and cranial nerve palsy during hospitalization were patient related factors independently associated with increased mortality. Accordingly, every drop of GCS from 15 was associated with increment of mortality by 21?% (AOR?=?0.79; 95?% CI?=?0.73C0.85). On the other hand, adjunctive dexamethasone therapy was found to be associated with over 3 times increment of mortality (AOR?=?3.38; 95?% CI?=?1.87C6.12) (Table?2). However, no association was seen between increased mortality and other conventional risk factors such as duration of illness, age of the patient and HIV infection. Table 2 Factors independently associated with poor outcomes at leaving hospital in patients treated as bacterial meningitis at teaching hospitals in Ethiopia, 2011C2015 C Focal neurologic deficits (AOR?=?3.33; Cryptotanshinone supplier 95?% CI 1.31C8.50), seizures (AOR?=?2.20; 95?% CI 1.03C4.67) and a low level of consciousness (AOR?=?2.65; 95?% 1.21C5.81) at admission were associated with the occurrence of neurologic sequelae at discharge. This analysis showed also that a delay of one day from symptom onset to hospital presentation was associated with 9?% increment in risk of neurologic sequelae (AOR?=?1.09; 95?% CI 1.01C1.16) (Table?2). As described above, 15?% of patients left hospital against medical advice or referred for better care. Separate analysis was done to assess if.