Impact of direct ICU admission of pneumococcal meningitis in France: a retrospective analysis of a French medico-administrative (PMSI) database

Michael Thy; Claire Dupuis; Arthur Mageau; Bruno Mourvillier; Lila Bouadma; Stéphane Ruckly; Anne Perozziello; Andrey Strukov; Damien Van-Gysel; Etienne de Montmollin; Romain Sonneville; Jean-François Timsit

doi:10.1186/s13613-023-01239-1

Impact of direct ICU admission of pneumococcal meningitis in France: a retrospective analysis of a French medico-administrative (PMSI) database

Ann Intensive Care. 2024 Jan 27;14(1):15. doi: 10.1186/s13613-023-01239-1.

Authors

Michael Thy^{1

2}, Claire Dupuis³, Arthur Mageau⁴, Bruno Mourvillier⁵, Lila Bouadma^{6

4}, Stéphane Ruckly⁴, Anne Perozziello⁴, Andrey Strukov⁷, Damien Van-Gysel⁷, Etienne de Montmollin^{6

4}, Romain Sonneville^{6

4}, Jean-François Timsit^{6

4}

Affiliations

¹ Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France. Michael.thy@aphp.fr.
² EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France. Michael.thy@aphp.fr.
³ Department of Intensive Care Medicine, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.
⁴ UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care INSERM Université Paris Cité, 75018, Paris, France.
⁵ Medical Intensive Care Unit, Robert Debré University Hospital, Reims, France.
⁶ Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France.
⁷ Department of Medical Information, Bichat Claude Bernard University Hospital, AP-HP, Université Paris Cité, Paris, France.

Abstract

Background: Current guidelines for adult patients with pneumococcal meningitis (PM) recommend initial management in intermediate or intensive care units (ICU), but evidence to support these recommendations is limited. We aimed to describe ICU admission practices of patients with PM.

Methods: We conducted a retrospective analysis of the French medico administrative database of consecutive adult patients with PM and sepsis criteria hospitalized between 2011 and 2020. We defined two groups, "Direct ICU" corresponding to a direct ICU admission and "Delayed ICU" corresponding to a secondary ICU admission.

Results: We identified 4052 patients hospitalized for a first episode of PM, including 2006 "Direct ICU" patients (50%) and 2046 "delayed ICU" patients (50%). The patients were mainly males [n = 2260 (56%)] with median age of 61 years [IQR 50-71] and a median Charlson index of 1 [0-3]. Among them, median SAPS II on admission was 46 [33-62], 2173 (54%) had a neurological failure on admission with 2133 (53%) in coma, 654 (16%) with brainstem failure, 488 (12%) with seizures and 779 (19%) with focal signs without coma. PM was frequently associated with pneumonia [n = 1411 (35%)], and less frequently with endocarditis [n = 317 (8%)]. The median ICU length of stay and hospital length of stay were 6 days [2-14] and 21 days [13-38], respectively. In-hospital mortality was 27% (n = 1100) and 640 (16%) patients were secondarily transferred to rehabilitation care unit. Direct ICU group was significantly more severe but after adjustment for age, sex, comorbidities, organ failures on admission and admission from home, direct ICU admission was significantly associated with a lower mortality (Odds ratio 0.67 [0.56-0.80], p < 0.01). This corresponded to one death avoided for 11 PM directly admitted in ICU.

Conclusions: Among patients with PM and sepsis, direct ICU admission was associated with lower mortality rates when compared to delayed admission.

Keywords: Direct admission; ICU; Mortality; Pneumococcal meningitis; Sepsis.