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Sex-Based Differences in Adults with Community-Acquired Bacterial Meningitis: a Prospective Cohort Study

2017Journal article Open access
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dc.contributor.authorDias, S
dc.contributor.authorBrouwer, M
dc.contributor.authorBijlsma, M
dc.contributor.authorEnde, A
dc.contributor.authorBeek, D
dc.date.accessioned2021-08-13T11:03:37Z
dc.date.available2021-08-13T11:03:37Z
dc.date.issued2017
dc.description.abstractObjectives: To investigate sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis. Methods: From January 2006 to July 2014, we prospectively investigated sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis in a nationwide cohort study in the Netherlands. Sex was analysed along with known predictors of unfavourable outcome using logistic regression. Results: We evaluated 1412 episodes of meningitis, 707 (50%) in men. Men more often presented with a history of remote head injury (41/667 (6%) versus 14/658 (2%) women, p 0.0002) or alcoholism (61/652 (9%) versus 21/660 (3%) women, p <0.0001). Neck stiffness was less common in men (453/651 (70%) versus 524/671 (78%) women, p 0.0004). Despite greater illness severity, women were less likely to receive treatment in an intensive care unit (odds ratio (OR) 0.72, 95% CI 0.58-0.89, p 0.003) or mechanical ventilation (OR 0.67, 95% CI 0.54-0.85, p 0.001). Women exhibited higher serum inflammatory parameters than men (median C-reactive protein 211 versus 171, p 0.0001; median erythrocyte sedimentation rate 48 versus 33, p <0.0001). Corticosteroids improved prognosis in both sexes, but absolute risk reduction was higher in women (20% versus 15%, p 0.001), although we found no significant interaction between sex and dexamethasone (p 0.38). In the multivariable analysis, male sex was an independent predictor of unfavourable outcome (OR 1.34, 95% CI 1.03-1.75, p 0.03) and death (OR 1.47, 95% CI 1.04-2.07, p 0.03). Conclusions: Our findings show sex-based differences in adults with community-acquired bacterial meningitis. Male sex is an independent risk factor for adverse outcome. It is possible that sex-based differences in immune reaction could determine a distinct response to corticosteroids.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationClin Microbiol Infect. 2017 Feb;23(2):121.e9-121.e15.pt_PT
dc.identifier.doi10.1016/j.cmi.2016.10.026.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3828
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectCHLC NEUpt_PT
dc.subjectAdolescentpt_PT
dc.subjectAdultpt_PT
dc.subjectAgedpt_PT
dc.subjectAnti-Bacterial Agents / therapeutic usept_PT
dc.subjectBiomarkerspt_PT
dc.subjectCommunity-Acquired Infections / diagnosispt_PT
dc.subjectCommunity-Acquired Infections / drug therapypt_PT
dc.subjectCommunity-Acquired Infections / epidemiologypt_PT
dc.subjectComorbiditypt_PT
dc.subjectCommunity-Acquired Infections / microbiologypt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectMeningitis, Bacterial / diagnosispt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectMeningitis, Bacterial / drug therapypt_PT
dc.subjectMeningitis, Bacterial / epidemiologypt_PT
dc.subjectMeningitis, Bacterial / microbiologypt_PT
dc.subjectNetherlands / epidemiologypt_PT
dc.subjectOdds Ratiopt_PT
dc.subjectProspective Studiespt_PT
dc.subjectSex Factorspt_PT
dc.subjectSeverity of Illness Indexpt_PT
dc.subjectYoung Adultpt_PT
dc.subjectTreatment Outcomept_PT
dc.titleSex-Based Differences in Adults with Community-Acquired Bacterial Meningitis: a Prospective Cohort Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage121.e15pt_PT
oaire.citation.startPage121.e9pt_PT
oaire.citation.titleClinical Microbiology and Infectionpt_PT
oaire.citation.volume23pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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