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April 2021; 11 (2) Research

Outcomes and Health Care Resource Utilization of Adult Bacterial Meningitis in the United States

Musa Kiyani, Sarah E. Hodges, Syed M. Adil, Lefko T. Charalambous, Beiyu Liu, View ORCID ProfileHui-Jie Lee, View ORCID ProfileBeth Parente, John R. Perfect, Shivanand P. Lad
First published May 29, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000868
Musa Kiyani
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
MD
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Sarah E. Hodges
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
BA
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Syed M. Adil
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
BS
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Lefko T. Charalambous
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
BS
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Beiyu Liu
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
PhD
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Hui-Jie Lee
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
PhD
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  • ORCID record for Hui-Jie Lee
Beth Parente
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
PA-C, MHS
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John R. Perfect
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
MD
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Shivanand P. Lad
Department of Neurosurgery (MK, SEH, SMA, LTC, BP, SPL), Department of Biostatistics and Bioinformatics (BL, H-JL), and Division of Infectious Diseases, Department of Medicine (JRP), Duke University Medical Center, Durham, NC.
MD, PhD
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Citation
Outcomes and Health Care Resource Utilization of Adult Bacterial Meningitis in the United States
Musa Kiyani, Sarah E. Hodges, Syed M. Adil, Lefko T. Charalambous, Beiyu Liu, Hui-Jie Lee, Beth Parente, John R. Perfect, Shivanand P. Lad
Neurol Clin Pract Apr 2021, 11 (2) 117-126; DOI: 10.1212/CPJ.0000000000000868

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Abstract

Objective To examine the longitudinal health care resource utilization, in-hospital mortality, and incidence of downstream complications of bacterial meningitis in the United States.

Methods Using IBM MarketScan, we retrieved data on adult patients with a diagnosis of bacterial meningitis admitted to a US hospital between 2008 and 2015. Patients were stratified into groups (1) with/without prior head trauma/neurosurgical complications, (2) nosocomial/community acquisition, and (3) Gram-negative/positive bacteria. Cost data were collected for up to 2 years and analyzed with descriptive statistics and longitudinal modeling.

Results Among 4,496 patients with bacterial meningitis, 16.5% and 4.6% had preceding neurosurgical complications and head injuries, respectively. Lumbar punctures were performed in 37.3% of patients without prior trauma/complications who went on to develop nosocomial meningitis, and those with prior head injuries or complications had longer initial hospital stays (17.0 days vs 8.0 days). Within a month of diagnosis, 29.2% of patients with bacterial meningitis had experienced downstream complications, most commonly hydrocephalus (12.7%). The worst 30-day mortality was due to tuberculous (12.3%) and streptococcal meningitis (7.2%). Overall, prior head trauma and complications were associated with higher costs. Community-acquired bacterial meningitis had lower median baseline costs relative to the nosocomial group (no head trauma/complication: $17,152 vs $82,778; head trauma/complication: $92,428 vs $168,309) but higher median costs within 3 months of diagnosis (no head trauma/complication: $47,911 vs $34,202; head trauma/complication: $89,207 vs $58,947). All costs demonstrated a sharp decline thereafter.

Conclusions Bacterial meningitis remains costly and devastating, especially for those who experience traumatic head injuries or have a complicated progress after neurosurgery.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • ↵* Co-first authors.

  • ↵† Authors who conducted statistical analyses.

  • Received November 21, 2019.
  • Accepted April 2, 2020.
  • © 2020 American Academy of Neurology
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