title: Changing epidemiology of adult bacterial meningitis in southern taiwan: a hospital-based study.
abstract: BACKGROUND
  Many factors may influence the epidemiologic trend of adult bacterial meningitis (ABM). The objective of this study was to analyze recent epidemiologic trends of ABM in order to provide a better therapeutic strategy.
  
  
  METHODS
  The clinical features, laboratory data, and therapeutic outcomes of 181 ABM cases collected in the last 6.5 years (July 1999-December 2005) were analyzed. The results were compared with those of our previous study (202 cases, January 1986-June 1999).
  
  
  RESULTS
  The 181 cases consisted of 130 men (age range: 18-82 years) and 51 women (age range: 18-78 years). Monomicrobial infection and mixed infection were found in 165 cases and 16 cases, respectively. A preceding postneurosurgical state was noted in 56.9% (103/181) of cases. Despite a decrease in incidence, Klebsiella pneumoniae (25.5%, 42/165) was still the most common pathogen. A marked increase of Acinetobacter meningitis (11.5%, 19/165) was noted, which replaced Pseudomonas meningitis as the second most common Gram-negative pathogen in ABM. A marked increase in staphylococcal infection, accounting for 23% (38/165) of all cases, was also noted, of which 76% (29/38) were methicillin-resistant strains. The therapeutic result showed a mortality rate of 30.3% (55/181). Significant prognostic factors included septic shock and age at infection.
  
  
  CONCLUSIONS
  This study revealed a change in the epidemiologic trend of ABM, with an increase in the number of patients with a postneurosurgical state and a rising incidence of Acinetobacter and staphylococcal infections. Clinicians should pay greater attention to these changes, which may affect their management of ABM.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, #123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, 833, Taiwan, ROC. cwenneng@ms19.hinet.net
authors.forename: W-N
authors.initials: WN
authors.lastname: Chang
authors.forename: C-H
authors.initials: CH
authors.lastname: Lu
authors.forename: C-R
authors.initials: CR
authors.lastname: Huang
authors.forename: N-W
authors.initials: NW
authors.lastname: Tsai
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chuang
authors.forename: C-C
authors.initials: CC
authors.lastname: Chang
authors.forename: S-F
authors.initials: SF
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Chien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000145:classification / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology