title: Adult community acquired bacterial meningitis in a Singaporean teaching hospital. A seven-year overview (1993-2000).
abstract: BACKGROUND
  The objective of this study is to describe the bacteriological, clinical and laboratory features of community acquired bacterial meningitis in adults admitted to a Singapore tertiary-care hospital.
  
  
  METHODS
  Two hundred sixty-nine cases of meningitis or meningoencephalitis admitted between 1993 and 2000 were identified by their discharge diagnosis codes. All case records except for 57 which could not be retrieved were retrospectively reviewed. Patients less than 14 years or with skull fractures, post-neurosurgery or with indwelling intracranial devices were excluded. Inclusion criteria was a clinical picture compatible with a diagnosis of bacterial meningitis with either (1) positive cerebral-spinal fluid (CSF) cultures or latex coagglutination or CSF neutrophilic pleocytosis accompanied by positive blood cultures or (2) in the absence of positive blood cultures, CSF cultures and latex agglutination, presence of CSF pleocytosis of at least 100 neutrophils per microL.
  
  
  RESULTS
  Fifteen "culture-positive" and 11 "culture negative" cases were identified. Six (55%) of the "culture-negative" cases received antibiotics prior to admission. Cultures grew Streptococcus pneumoniae in four cases, three cases each of Group B streptococci and Neisseria meningitides. Listeria monocytogenes and Klebsiella pneumoniae were each seen twice and Streptococcus suis once. All cases of Group B streptococci occurred in the year 1998. Mortality was 19% (n = 5), six developed infections in other sites, three epileptic seizures, three developed hydrocephalus, and two hearing loss.
  
  
  CONCLUSIONS
  Pathogens are similar to those reported in other studies but for an outbreak of Group B Streptococcus in 1998. There were a high number of "culture-negative" cases which may be due to preceding antibiotic intervention.
authors.affiliation: Division of Neurology, Department of Medicine, National University Hospital, Singapore.
authors.forename: Y C
authors.initials: YC
authors.lastname: Chan
authors.forename: A
authors.initials: A
authors.lastname: Wilder-Smith
authors.forename: B K C
authors.initials: BK
authors.lastname: Ong
authors.forename: G
authors.initials: G
authors.lastname: Kumarasinghe
authors.forename: E
authors.initials: E
authors.lastname: Wilder-Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000401:mortality; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000401:mortality; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D013290:Streptococcal Infections / Q000175:diagnosis / Q000401:mortality; D013292:Streptococcus agalactiae; D016019:Survival Analysis