[Bacterial meningitis due to gram-negative bacilli in adults].
BACKGROUND
Gram-negative bacilli are causative agents of bacterial meningitis in the neonatal period but rarely cause meningitis in adults without risk factors.


OBJECTIVE
To report on meningitis due to gram-negative bacilli (MGNB) in adults diagnosed in a hospital over a 25-year period.


METHODS
We reviewed the medical records of all patients with an age > or = 14 years who had been diagnosed with MGNB between 1982 and 2006.


RESULTS
Fifteen cases of MGNB are included (10.5% of the cases of bacterial meningitis with an identified aetiology), with a mean age of 48 years (14-79). Twelve (80%) were post-operative: recent neurosurgery (9 cases, 75%) and having a neurosurgical device (8 cases, 67%) were risk factors. Three (20%) were spontaneous: two were of a urinary origin and one had an undetermined origin. The aetiology was: Pseudomonas aeruginosa (3 cases), Escherichia coli (3 cases), Enterobacter aerogenes (2 cases), Pseudomonas fluorescens (1 case), Klebsiella pneumoniae (1 case), Morganella morganii (1 case), Acinetobacter anitratus (1 case), Acinetobacter iwoffii (1 case) and Flavobacterium brevis (1 case); in one patient with Gram positive staining for gram-negative bacilli, the culture was negative, and three of them (20%) were mixed infections (Staphylococcus spp.). Three patients (20%) died.


CONCLUSIONS
In adults, gram-negative bacilli rarely cause spontaneous meningitis, but are a common causation of post-neurosurgical meningitis and in those with neurosurgical devices. The mortality rate of MGNB is high.
Laguna-del Estal
Pedro
P
Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. pld02m@saludalia.com
García-Montero
Pablo
P
Agud-Fernández
María
M
López-Cano Gómez
María
M
Castañeda-Pastor
Ana
A
García-Zubiri
Carlos
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006090:Gram-Negative Bacteria / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult