[Comparative study of meningitis due to Staphylococcus aureus and coagulase-negative Staphylococci in adults].
BACKGROUND
Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they are a frequent cause of nosocomial meningitis. AIMS. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults.


METHODS
We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp.


RESULTS
Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoN Staphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent in infections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%).


CONCLUSIONS
Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially in the post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus.
Laguna-Del Estal
P
P
Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España. pld02m@saludalia.com
Castañeda-Pastor
A
A
Gil-Navarro
M
M
García-Madero
R
R
López-Cano Gómez
M
M
Agud-Fernández
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D003030:Coagulase / Q000032:analysis*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000382:microbiology*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013210:Staphylococcus / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D055815:Young Adult
D003030:Coagulase