Streptococcal meningitis in adults: therapeutic outcomes and prognostic factors.
Thirty-eight patients with streptococcal meningitis, aged 17-75 years, have been identified over a period of 13.5 years. Among these 38 patients, 35 had community-acquired infections, and the other three had nosocomial infections. Twelve of the 38 patients were found to have postneurosurgical forms and 26 to have spontaneous forms. These 38 cases of streptococci included Streptococcus (S.) pneumoniae in 19 cases, viridans group streptococci in 13, non-A, non-B, and non-D streptococci in three, Group D streptococci in one, and Group B streptococci (S. agalactiae) in two. Although one case was found to have penicillin-resistant S. pneumoniae PRSP in 1994, multi-antibiotic resistant strains were rare in this study. Therapeutic outcomes varied according to the different species of streptococci. In this study, the overall mortality rate was 34%. In the multiple logistic regression analysis, only initial consciousness level and the presence of seizure were strongly associated with the mortality rate even after other potentially confounding factors were adjusted for. Early diagnosis and the use of appropriate antibiotics are essential for survival.
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Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC. chlu99@ms44.url.com.tw
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Chang
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002701:Chloramphenicol / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008586:Meningitis, Pneumococcal / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D008875:Middle Aged; D010068:Oxacillin / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use*; D011379:Prognosis; D012044:Regression Analysis; D013291:Streptococcus / Q000302:isolation & purification; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002701:Chloramphenicol; D002443:Ceftriaxone; D002442:Ceftazidime; D010068:Oxacillin