Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study
Open accessAbstract
INTRODUCTION: Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice. METHODS: Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed. RESULTS: One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15%. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8% of the cohort for 2004 to 30% in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model. CONCLUSIONS: We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality.
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Subgroup analysis showed a significant reduction in mortality in S. pneumoniae meningitis but not in N. meningitidis or H. influenzae meningitis.
“Subgroup analysis in this data showed a significant reduction in mortality in S. pneumoniae meningitis but not in N. meningitidis or H. influenzae meningitis.53”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [53]
In Results > Rifampin use (page unavailable), Table 2 reports a significant unadjusted association between rifampin given within 24 hours and lower ICU mortality in S. pneumoniae meningitis (p=0.031). It does not report corresponding subgroup analyses for N. meningitidis or H. influenzae. The Discussion also says the multivariate analysis found no association between rifampin use and ICU mortality, so the claim overstates the finding as a reduction in mortality. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe 2015 Cochrane review showed severe hearing loss was significantly reduced by corticosteroids; this was especially true in high-income countries.
“The 2015 Cochrane review showed severe hearing loss was significantly reduced by corticosteroids; this was especially true in high-income countries.”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [53]
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References 49 · Cited by 24
Research works printed but not linked: 2
- [47]Rifampin. Tuberculosis (Edinb). 2008;88:151–4.
- [49]Bretonnière C, Jozwiak M, Giraud C, Beuret P, Trouillet J, Teboul J, et al. Acute community acquired meningitis in the ICU: early treatment with rifampicin is associated with lower mortality [L1-1224]. Presented at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 2012, 9–12 September 2012, San Francisco, CA, USA.
- Authors
- Bretonnière, C., Jozwiak, M., Girault, C., Beuret, P., Trouillet, J.-L., Anguel, N., Caillon, J., Potel, G., Villers, D., Boutoille, D., & Guitton, C.
- Affiliations
- Centre Hospitalier Universitaire de Nantes (FR)
- Hôpital Charles-Nicolle (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Bretonnière, Cédric
- ORCID
- Venue
- Critical Care
- Published
- 2015-12
- Volume
- 19
- Issue
- 1
- Pages
- 303-303
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC4549935
- OpenAlex
- W1957527125
- Cited by
- 24
- References
- 49
- Citations by year
- 2026: 3 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 2 · 2015: 1
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Association pour le Développement de la Réanimation (ACAM-ICU)
- Nantes University Hospital (PROG/10/14)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Pharmacology › Antibiotics Pharmacokinetics and Efficacy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- rifampicin, bacterial meningitis, community-acquired meningitis, ICU mortality, Streptococcus pneumoniae, Neisseria meningitidis, pneumococcal meningitis, cephalosporin therapy, vancomycin, timing of antibiotic administration, organ failure, Glasgow Outcome Scale
- MeSH terms
- Anti-Bacterial Agents, Female, France, Humans, Intensive Care Units, Male, Meningitis, Meningococcal, Meningitis, Pneumococcal, Middle Aged, Neisseria meningitidis, Retrospective Studies, Rifampin, Treatment Outcome, Meningitis, Bacterial, Hospital Mortality, Community-Acquired Infections, Glasgow Outcome Scale
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