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• W2062989069 abstract "We congratulate Rodrigo Lopez Castelblanco and colleagues on their study of the epidemiology of bacterial meningitis in the USA.1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar The decreasing incidence and mortality of pneumococcal meningitis are welcome, and we agree that use of effective vaccines and possibly corticosteroid therapy has contributed to this decrease.Although these epidemiological data are interesting, practising physicians might find the probable mortality of an individual patient to be of more interest than epidemiological data. To estimate the probability of death from pneumococcal meningitis, we used data reported in figures 1 and 2 of the study1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar and divided the mortality rate by the incidence in a given year. In 1997 the mortality of pneumococcal meningitis was 11% (0·09/0·81). In 2008, the last year for which both incidence and mortality rates were reported,1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar the probability of death decreased to 6% (0·025/0·4). The reported mortality in adult patients with pneumococcal meningitis in the modern era has been reported to range between 21% and 30%.2Schuchat A Robinson K Wenger JD et al.Bacterial meningitis in the United States. Active Surveillance Team.N Engl J Med. 1997; 337: 970-976Crossref PubMed Scopus (999) Google Scholar, 3van de Beek D de Gans J Spanjaard L Weisfelt M Reitsma JB Vermeulen M Clinical features and prognostic factors in adults with bacterial meningitis.N Engl J Med. 2004; 351: 1849-1859Crossref PubMed Scopus (1086) Google Scholar The mortality in paediatric pneumococcal meningitis is lower than for adults and ranges from 8% to 15%.4Baraff LJ Lee SI Schriger DL Outcomes of bacterial meningitis in children: a meta-analysis.Pediatr Infect Dis J. 1993; 12: 389-394Crossref PubMed Scopus (442) Google Scholar, 5Arditis M Mason Jr, EO Bradley JS et al.Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use.Pediatrics. 1998; 102: 1087-1097Crossref PubMed Scopus (256) Google ScholarThe reduced mortality values derived from the data presented in this study1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar raise the question of whether the individual mortality of a patient with pneumococcal meningitis has actually decreased in the modern era or whether the actual mortality is underestimated by the methods used in this study.We declare no competing interests. We congratulate Rodrigo Lopez Castelblanco and colleagues on their study of the epidemiology of bacterial meningitis in the USA.1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar The decreasing incidence and mortality of pneumococcal meningitis are welcome, and we agree that use of effective vaccines and possibly corticosteroid therapy has contributed to this decrease. Although these epidemiological data are interesting, practising physicians might find the probable mortality of an individual patient to be of more interest than epidemiological data. To estimate the probability of death from pneumococcal meningitis, we used data reported in figures 1 and 2 of the study1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar and divided the mortality rate by the incidence in a given year. In 1997 the mortality of pneumococcal meningitis was 11% (0·09/0·81). In 2008, the last year for which both incidence and mortality rates were reported,1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar the probability of death decreased to 6% (0·025/0·4). The reported mortality in adult patients with pneumococcal meningitis in the modern era has been reported to range between 21% and 30%.2Schuchat A Robinson K Wenger JD et al.Bacterial meningitis in the United States. Active Surveillance Team.N Engl J Med. 1997; 337: 970-976Crossref PubMed Scopus (999) Google Scholar, 3van de Beek D de Gans J Spanjaard L Weisfelt M Reitsma JB Vermeulen M Clinical features and prognostic factors in adults with bacterial meningitis.N Engl J Med. 2004; 351: 1849-1859Crossref PubMed Scopus (1086) Google Scholar The mortality in paediatric pneumococcal meningitis is lower than for adults and ranges from 8% to 15%.4Baraff LJ Lee SI Schriger DL Outcomes of bacterial meningitis in children: a meta-analysis.Pediatr Infect Dis J. 1993; 12: 389-394Crossref PubMed Scopus (442) Google Scholar, 5Arditis M Mason Jr, EO Bradley JS et al.Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use.Pediatrics. 1998; 102: 1087-1097Crossref PubMed Scopus (256) Google Scholar The reduced mortality values derived from the data presented in this study1Castelblanco RL Lee M Hasbun R Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study.Lancet Infect Dis. 2014; 14: 813-819Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar raise the question of whether the individual mortality of a patient with pneumococcal meningitis has actually decreased in the modern era or whether the actual mortality is underestimated by the methods used in this study. We declare no competing interests. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational studyS pneumoniae continues to be the leading identifiable cause of bacterial meningitis in the USA, but with a significant decrease in incidence and mortality associated with the introduction of conjugated vaccines and a mortality decrease that is associated with the introduction of recommendations for use of adjunctive dexamethasone for pneumococcal meningitis. Full-Text PDF" @default.
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