Adjunctive dexamethasone treatment in adults with listeria monocytogenes meningitis: a prospective nationwide cohort study.

Abstract

A French cohort study described a detrimental effect of adjunctive dexamethasone treatment in listeria meningitis. Based on these results guidelines recommend not to use dexamethasone if <i>L. monocytogenes</i> is suspected or stop dexamethasone when the pathogen is detected. We studied clinical characteristics, treatment regimens and outcome of adults with <i>Listeria monocytogenes</i> meningitis in a nationwide cohort study on bacterial meningitis. We prospectively assessed adults with community-acquired <i>L. monocytogenes</i> meningitis in the Netherlands between Jan 1, 2006, and July 1, 2022. We identified independent predictors for an unfavourable outcome (Glasgow Outcome Scale score 1 to 4) and mortality by logistic regression. 162 out of 2664 episodes (6%) of community-acquired bacterial meningitis episode were caused by <i>L. monocytogenes</i> in 162 patients. Adjunctive dexamethasone 10 mg QID was started with the first dose of antibiotics in 93 of 161 patients (58%) and continued for the full four days in 83 (52%) patients. Different doses, duration or timing of dexamethasone were recorded in 11 patients (7%) and 57 patients (35%) did not receive dexamethasone. The case fatality rate was 51 of 162 (31%) and an unfavourable outcome occurred in 91 of 162 patients (56%). Age and the standard regimen of adjunctive dexamethasone were independent predictors for an unfavourable outcome and mortality. The adjusted odds ratio of dexamethasone treatment for unfavourable outcome was 0.40 (95% confidence interval 0.19-0.81). Adjunctive dexamethasone is associated with an improved outcome in patients with <i>L. monocytogenes</i> meningitis and should not be withheld if <i>L. monocytogenes</i> is suspected or detected as causative pathogen. European Research Council and Netherlands Organisation for Health Research and Development.