Nosocomial bacterial meningitis in adults: a prospective series of 50 cases.
In order to evaluate characteristics of nosocomial meningitis in adults, we performed a prospective cohort study of 50 episodes of nosocomial bacterial meningitis. These cases were confirmed by culture of cerebrospinal fluid (CSF) in patients aged >16 years. Classic symptoms of bacterial meningitis (headache, neck stiffness and fever) were present in >70% of the episodes, although only a minority (41%) presented with impairment of consciousness. Underlying conditions, such as a history of neurosurgery, recent head injury, CSF leakage or a distant focus of infection, were present in 94% of the episodes. Staphylococcus aureus was the most common pathogen in patients with a history of neurosurgery, causing 10 of 32 episodes (31%). Patients with a distant focus of infection, such as otitis, sinusitis or pneumonia were more likely to have meningitis due to Streptococcus pneumoniae than patients without [six of nine episodes (67%) vs seven of 41 (17%); P=0.01]. Complications occurred in 50% of the episodes and 16% of the patients died. Our study confirms that adults with nosocomial meningitis are a distinct patient group with specific bacterial pathogens, as compared to those with community-acquired bacterial meningitis. Underlying conditions, especially a history of neurosurgery or a distant focus of infection, were present in the large majority of patients, and mortality and morbidity rates were high.
Weisfelt
M
M
Center of Infection and Immunity Amsterdam, Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. m.weisfelt@amc.uva.nl
van de Beek
D
D
Spanjaard
L
L
de Gans
J
J
D000328:Adult; D000368:Aged; D015984:Causality; D003428:Cross Infection / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D016905:Gram-Negative Bacterial Infections / Q000134:cerebrospinal fluid; D016908:Gram-Positive Bacterial Infections / Q000134:cerebrospinal fluid; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors