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To report the prevalence of delayed cerebral injury in adults with bacterial meningitis and explore its association with adjunctive steroids.Retrospective analysis of adults with bacterial meningitis between 2005 and 2016.Ten hospitals in the Greater Houston area.Consecutive subjects with culture proven community-acquired bacterial meningitis.Subjects were categorized as receiving or not adjunctive steroids within 4 hours.A total of 120 patients were identified who were admitted with community-acquired bacterial meningitis. Delayed cerebral injury was seen in five of 120 patients (4.1%); all five patients had fever and abnormal neurologic examinations. Adjunctive steroids within 4 hours were more likely given to those with delayed cerebral injury (5/5,100% vs 43/115, 37.5%; p = 0.01). Of the patients who developed delayed cerebral injury, three had Streptococcus pneumoniae, one had methicillin-resistant Staphylococcus aureus, and one had Listeria monocytogenes isolated. We observed an adverse clinical outcome as defined by the Glasgow Outcome Scale in four of the five patients (80%).Delayed cerebral injury occurred in 4.1% of adults with bacterial meningitis, and it was associated with the use of adjunctive steroids. Future studies should explore the etiology and prevention of this devastating complication.