title: Bacterial meningitis in young adults in Southern Taiwan: clinical characteristics and therapeutic outcomes.
abstract: BACKGROUND
  To delineate the epidemiologic trend, clinical characteristics and therapeutic outcomes of bacterial meningitis in young adults in Southern Taiwan.
  
  
  METHODS
  Over a period of 18 years, 329 cases of culture-proven adult bacterial meningitis were identified at our hospital. Among these 329 cases, 62 were identified as young adults (< or = 40 years) and their clinical features, laboratory data and therapeutic outcomes were reviewed. The prognostic factors between fatal and non-fatal groups were compared.
  
  
  RESULTS
  The 62 young adults were 48 men and 14 women, aged 17-40 years. Thirty of the 62 patients belonged to nosocomial infection, and the other 32 belonged to community-acquired infection. A total of 74% (46/62) of the patients had a post-neurosurgical state as the underlying condition. Alcoholism (n = 8) was the most common underlying condition of the other 16 patients with spontaneous meningitis. Of these 62 patients, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common implicated gram-negative pathogens. During the late study period, there was an increase in coagulase-negative staphylococcus and Staphylococcus aureus infections. The therapeutic results of this group of patients are as follows: 13 patients died, 18 had full recovery and 31 had varying degrees of neurologic deficits. Impaired consciousness and thrombocytopenia were significant prognostic factors.
  
  
  CONCLUSIONS
  A post-neurosurgical state is an important preceding event for young adults to develop bacterial meningitis. Of the implicated gram-negative pathogens, K. pneumoniae and P. aeruginosa are common; however, there has been an increase in staphylococcal infection in recent years. Therapeutic results of this specific group of patients showed that 20% (13/62) of the patients died, and 50% (31/61) of the patients in this study had neurologic deficits. However, the small case number and possible bias of case selection has limited the analytical conclusions of this study. Further large-scale studies are needed to delineate the clinical characteristics and therapeutic outcomes of bacterial meningitis in this specific group of patients.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
authors.forename: M-H
authors.initials: MH
authors.lastname: Tsai
authors.forename: C-H
authors.initials: CH
authors.lastname: Lu
authors.forename: C-R
authors.initials: CR
authors.lastname: Huang
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chuang
authors.forename: N-W
authors.initials: NW
authors.lastname: Tsai
authors.forename: H-H
authors.initials: HH
authors.lastname: Tsai
authors.forename: S-F
authors.initials: SF
authors.lastname: Chen
authors.forename: C-S
authors.initials: CS
authors.lastname: Li
authors.forename: H-W
authors.initials: HW
authors.lastname: Chang
authors.forename: C-C
authors.initials: CC
authors.lastname: Chien
authors.forename: W-N
authors.initials: WN
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012307:Risk Factors; D013210:Staphylococcus / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome