Predictors of Mortality and Clinical Outcomes in Adult Bacterial Meningitis in Northern Vietnam: A Seven-Year Cohort Analysis

Background: Bacterial meningitis remains a major cause of neurological morbidity and mortality, particularly in low-and middle-income countries.To better characterise the aetiology, clinical features, and prognostic determinants, we conducted a seven-year investigation of adult bacterial meningitis cases admitted to a large tertiary hospital in northern Vietnam.Methods: A retrospective-prospective observational cohort study was conducted between 2018 and 2024, including adults diagnosed with bacterial meningitis.Clinical characteristics, cerebrospinal fluid (CSF) parameters, culture results, and targeted inhouse PCR findings were analysed.Outcomes were assessed using Glasgow Outcome Scale (GOS), with unfavourable outcomes defined as GOS 1-4.Multivariate logistic regression identified independent predictors of mortality and unfavourable outcomes.Results: Of 232 screened patients, 150 met inclusion criteria.Pathogens were identified in 62 (41%) cases.Streptococcus suis was the predominant pathogen (n=26), followed by Streptococcus pneumoniae (n=10).CSF culture yielded growth in 35% of cases, while PCR detected six additional culture-negative infections.Overall mortality was 5%, and 10% of patients experienced unfavourable outcomes.Independent predictors included alcoholism (unfavourable outcome OR 13.8, 95% CI 2.1-100; mortality OR 16.5, 95% CI 1.9-165), focal neurological deficits (unfavourable outcome OR 41.4, 95% CI 9.2-250; mortality OR 12.8, 95% CI 1.7-123), and altered mental status (OR 8.6, 95% CI 1.5-86). Conclusions: S. suis remains the leading cause of adult bacterial meningitis in northernVietnam.Targeted interventions addressing high-risk groups, particularly individuals with alcoholism or neurological deficits at presentation, could improve clinical outcomes.