Community-acquired bacterial meningitis in elderly patients: experience over 30 years.
Clinical characteristics, etiologies, evolution, and prognostic factors of community-acquired bacterial meningitis in elderly patients are not well known. To improve this knowledge, all episodes of community-acquired bacterial meningitis were prospectively recorded and cases occurring in patients >or=65 years old were selected. During the period 1977-2006, 675 episodes in adults (aged >or=18 yr) were recorded, with 185 (27%) in patients aged >or=65 years old; 76 were male and 109 were female, with a mean age of 73 +/- 6 years (range, 65-93 yr). Causative microorganisms were Streptococcus pneumoniae 74, Neisseria meningitidis 49, Listeria monocytogenes 17, other streptococcal 9, Escherichia coli 6, Haemophilus influenzae 4, Klebsiella pneumoniae and Staphylococcus aureus 2 each, Capnocytophaga canimorsus and Enterococcus faecalis 1 each, and unknown in 20. On admission 91% had had fever, 32% were in a coma (Glasgow Coma Scale <or=8), 9% presented with seizures, and 8% with shock. Thirty patients (16%) presented with seizures during therapy. Mortality was 58/185 (31%). Compared with patients aged 18-65 years, there were significant differences among older patients (aged >or=65 yr), who showed a higher frequency of diabetes and malignancy as underlying disease; pneumonia, otitis, and pericranial fistula as predisposing factors; and S. pneumoniae and L. monocytogenes as etiology. There were also differences in clinical presentation, complications, sequelae, and mortality. Factors independently related with mortality were age, pneumonia as a predisposing factor, coma on admission, and heart failure and seizures after therapy. Dexamethasone therapy was a protective factor. In conclusion, bacterial meningitis in elderly patients is associated with greater diagnostic difficulties and neurologic severity and more complications, as well as with increased mortality. Antiseizure prophylaxis might be useful in these patients.
Cabellos
Carmen
C
From the Infectious Diseases Service (CC, MO, NFS, XA, FG, PFV) and Microbiology Service (RV, MC). IDIBELL. Hospital Universitari de Bellvitge, Barcelona, Spain.
Verdaguer
Ricard
R
Olmo
Montse
M
Fernández-Sabé
Nuria
N
Cisnal
Maria
M
Ariza
Javier
J
Gudiol
Francesc
F
Viladrich
Pedro F
PF
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000382:microbiology; D005402:Fistula / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006955:Hypernatremia / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D010031:Otitis / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D012640:Seizures / Q000453:epidemiology / Q000382:microbiology; D012769:Shock / Q000453:epidemiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology