{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:34:51Z","timestamp":1792481691689,"version":"4.5.0"},"reference-count":669,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.<\/jats:p><\/jats:sec>Data Sources<\/jats:title>Google Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis<\/jats:italic> and mortality<\/jats:italic>.<\/jats:p><\/jats:sec>Study Selection<\/jats:title>Included studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care\u2013associated meningitis, tuberculous meningitis, or missing outcome were excluded.<\/jats:p><\/jats:sec>Data Extraction and Synthesis<\/jats:title>Data were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period\u2019s year as an estimator variable were used.<\/jats:p><\/jats:sec>Main Outcome and Measure<\/jats:title>Case fatality ratios of bacterial meningitis.<\/jats:p><\/jats:sec>Results<\/jats:title>This review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157\u202f656 episodes. Of the 33\u202f295 episodes for which the patients\u2019 sex was reported, 13\u202f452 (40%) occurred in females. Causative pathogens were reported in 104\u202f598 episodes with Neisseria meningitidis<\/jats:italic> in 26\u202f344 (25%) episodes, Streptococcus pneumoniae<\/jats:italic> in 26\u202f035 (25%) episodes, Haemophilus influenzae<\/jats:italic> in 22\u202f722 (22%), other bacteria in 19\u202f161 (18%) episodes, and unidentified pathogen in 10\u202f336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes<\/jats:italic> at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae<\/jats:italic> at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli<\/jats:italic>, or Streptococcus agalactiae<\/jats:italic> (P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.24802","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T15:34:34Z","timestamp":1722612874000},"page":"e2424802","source":"Crossref","is-referenced-by-count":67,"title":["Global Case Fatality of Bacterial Meningitis During an 80-Year Period"],"prefix":"10.1001","volume":"7","author":[{"given":"Cornelis N.","family":"van Ettekoven","sequence":"first","affiliation":[{"name":"Department of Neurology, Amsterdam Neuroscience, 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