Bacterial meningitis in hemodialyzed patients.
BACKGROUND
To analyze the clinical features, causative pathogens and therapeutic outcomes of bacterial meningitis in hemodialyzed patients.


METHODS
Two hundred and sixty-seven patients, > or = 16 yrs, were identified with culture-proven bacterial meningitis. In addition, the causative pathogens and therapeutic outcomes between uremic and non-uremic patients with adult bacterial meningitis were analyzed.


RESULTS
Nine uremic patients with bacterial meningitis, accounting for 3% (9/267) of our adult patients with culture-proven bacterial meningitis had fever, disturbed consciousness and seizures. These were the three most common manifestations in our patients. The interval between the onset of symptoms and therapy start was 5-11 days (mean: 9 days). No patients were initially diagnosed with bacterial meningitis, two patients were initially suspected of having infection of unknown origin. In the non-uremic patient group, klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae were the most frequently detected pathogens, while pseudomonas aeruginosa and coagulase-negative Staphylococcus were the most prevalent in the uremic patients group. The overall mortality rates for the non-uremic and uremic patient groups were 33 and 78% respectively.


CONCLUSIONS
The mortality rate for bacterial meningitis in the uremic patients group remained high. Due to non-specific manifestations and slow evolution, bacterial meningitis was commonly misdiagnosed as uremic encephalopathy. Therefore, effective treatment was usually delayed. To avoid treatment failure, early diagnosis, careful monitoring of clinical condition and appropriate antibiotic choices are necessary.
Cheng
Ben-Chung
BC
Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chang
Wen-Neng
WN
Lu
Cheng-Hsien
CH
Chen
Jin-Bor
JB
Chang
Chen-Sheng
CS
Lee
Chih-Hsiung
CH
Lee
Chien-Te
CT
Chen
Te-Chuan
TC
Pan
Hsien-Heng
HH
Hsu
Kuo-Tai
KT
Huang
Chi-Ren
CR
Tsai
Nai-Wen
NW
Chang
Chin-Jung
CJ
Hung
Pi-Lien
PL
Wang
Kuo-Wei
KW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications* / Q000628:therapy