Table 2.
Survival for Adults Reported to be Hospitalized for Anthrax by Meningitis Status, Route of Infection, Systemic Criteria, and Treatment During First 2 Days of Hospitalization,a 1940–2018
| Without Meningitis | With Meningitis | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Localized Cutaneous | Systemic Cutaneous | Ingestion | Inhalation | Nonsystemicb,c | Systemicb,d | |||||||||
| Treatment | (N = 93) | (N = 61) | (N = 16) | (N = 19) | (N = 100) | (N = 136) | (N = 46) | |||||||
| Nonee | 3/6 | (50%) | 1/2 | (50%) | 2/3 | (67%) | 0/2 | (0%) | 3/6 | (50%) | 4/9 | (44%) | 0/9 | (0%) |
| 1 Abx classf | 61/62 | (98%) | 44/45 | (98%) | 5/8 | (63%) | 1/6 | (17%) | 62/64 | (97%) | 55/65 | (85%) | 3/14 | (21%) |
| 2 Abx classes | 7/7 | (100%) | 8/8 | (100%) | 0/4 | (0%) | 4/4 | (100%) | 7/7 | (100%) | 14/19 | (74%) | 0/10 | (0%) |
| ≥3 Abx classes | 8/8 | (100%) | 1/1 | (100%) | 0/1 | (0%) | 3/6 | (50%) | 13/13 | (100%) | 17/24 | (71%) | 3/8 | (38%) |
| Antiserumg | … | … | 2/2 | (100%) | … | … | … | … | … | … | 2/2 | (100%) | 0/1 | (0%) |
| Antiserum and 1 Abx class | 8/8 | (100%) | … | … | … | … | … | ... | 8/8 | (100%) | 0/1 | (0%) | 1/2 | (50%) |
| Antiserum and ≥2 Abx classes | 1/1 | (100%) | … | … | … | … | … | ... | 1/1 | (100%) | 6/8 | (75%) | 0/1 | (0%) |
| Bactericidal(s) | 60/61 | (98%) | 47/48 | (98%) | 5/11 | (45%) | 3/8 | (38%) | 61/63 | (97%) | 59/71 | (83%) | 4/18 | (22%) |
| PSI(s) | 11/11 | (100%) | 5/5 | (100%) | 0/1 | (0%) | 1/3 | (33%) | 11/11 | (100%) | 7/11 | (64%) | 0/2 | (0%) |
| Bactericidal(s) and PSI(s) | 6/6 | (100%) | 4/4 | (100%) | 0/1 | (0%) | 4/5 | (80%) | 11/11 | (100%) | 27/33 | (82%) | 3/13 | (23%) |
Abbreviations: Abx, antimicrobial; PSI, protein synthesis inhibitor.
Treatments in this table refer to antimicrobials, antitoxin/antiserum, or a combination of both. Each line is the number of patients that survived divided by the total number that received that treatment only (eg, “single antimicrobial” means that they received a single antimicrobial and they did not receive antitoxin/antiserum. “Bactericidal(s)” means that they received 1 or more bactericidal antimicrobial(s) but no protein synthesis inhibitor and no antitoxin/antiserum). Sulfa drugs and cephalosporins are not considered anthrax-appropriate antimicrobial treatment and therefore did not contribute to the count of antimicrobials in this table. Patients described by author Meselson (N = 76) were excluded because they lacked treatment data [2]. Additional exclusions included 1 patient who was dead on arrival, 65 who died on their first day of hospitalization, and 8 who lacked survival status. Thirteen patients had at least 1 antimicrobial other than a sulfa or cephalosporin before hospitalization and 8 patients had their first treatment after day 2 of hospitalization and were excluded from this table. A few patients had unclear treatment timing and could not be classified.
Systemic refers to our definition published in “Identifying Meningitis During an Anthrax Mass Casualty Incident: Systemic Review of Systemic Anthrax Since 1880” except that we removed the qualification of “death” [11].
Nonsystemic patients lacking meningitis consisted of the following: 93 cutaneous and 7 injection.
Systemic patients lacking meningitis consisted of the following: 61 cutaneous, 16 ingestion, 19 inhalation, and 40 injection.
“None” refers to no antimicrobials or antitoxin/antiserum given at all before or throughout hospitalization. This is the only category that is not restricted to the first 2 days of hospitalization.
Antimicrobials are lumped into classes; therefore, having 1 antimicrobial refers to 1 class of antimicrobials, 2 antimicrobials refers to having 2 different classes of antimicrobials, etc.
This includes both antiserum and antitoxin.