title: Methicillin-resistant Staphylococcus aureus meningitis in adults: a multicenter study of 86 cases.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is an uncommon disease, and little is known about its epidemiology, clinical features, therapy, and outcome. We performed a multicenter retrospective study of MRSA meningitis in adults. Eighty-six adult patients were included and the following data were obtained: underlying diseases, clinical presentation, analytical and microbiologic data, response to therapy, and outcome.There were 56 men (65%) and the mean age was 51.5 years; 54 of them (63%) had severe comorbidities. There were 78 cases of postoperative meningitis and 8 of spontaneous meningitis. The infection was nosocomial in 93% (80/86) of the cases. Among the 78 patients with postoperative meningitis, the most common predisposing conditions were cerebrospinal fluid (CSF) devices (74%), neurosurgery (45%), CSF leakage (17%), and head trauma (12%). Most patients had fever (89%), altered mental status (68%), headache (40%), and meningeal signs (29%). The most common CSF findings were pleocytosis (90%), elevated protein level (77%), and hypoglycorrhachia (30%). CSF Gram stain and blood cultures were positive in 49% (32/65) and 36% (16/45) of cases, respectively. An associated MRSA infection and polymicrobial meningitis appeared in 33% (28/86) and 23% (20/86) of cases, respectively. Antimicrobial therapy was given to 84 patients. Most of them received vancomycin (92%) either as monotherapy (64%) or in combination with other antibiotics (28%), for a median of 18 days. Overall 30-day mortality was 31% (27/86). Multivariate study identified 2 independent factors associated with mortality: spontaneous meningitis (odds ratio [OR], 21.4; 95% confidence interval [CI], 2.3-195.4; p = 0.007), and coma (OR, 9.7; 95% CI, 2.2-42.3; p = 0.002).In conclusion, MRSA is a relatively uncommon but serious disease. Although most cases are nosocomial infections appearing in neurosurgical patients, spontaneous meningitis may present as a community-onset infection in patients with severe comorbidities requiring frequent contact with the health care system. Most patients have a favorable response to vancomycin, but the beneficial effect of combined and intraventricular therapy, or alternative drugs, remains unclear. MRSA meningitis is associated with a high mortality, and the presence of spontaneous infection and coma are the most important prognostic factors.
authors.affiliation: From Infectious Diseases Service (VP, RP), Hospital Ramón y Cajal, Madrid; Infectious Diseases Service (MEJ-M), Hospital Virgen del Rocío, Sevilla; Infectious Diseases Unit (AR-G), Hospital Central de Asturias, Oviedo; Department of Internal Medicine (AG), Hospital La Paz, Madrid; Department of Clinical Microbiology (JMG-L), Hospital Gregorio Marañón, Madrid; Infectious Diseases Service, Hospital Bellvitge (CC), L'Hospitalet de Llobregat, Barcelona; Microbiology Department (FC), Hospital Doce de Octubre, Madrid; Infectious Diseases Unit (PD), Hospital de la Santa Creu i Sant Pau, Barcelona; Infectious Diseases Unit (AR), Hospital Puerta de Hierro-Majadahonda, Madrid; Clinical Microbiology Service (EP-C), Hospital Clínico San Carlos, Madrid; Microbiology Service (DD), Hospital La Princesa, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.forename: Rosario
authors.initials: R
authors.lastname: Pazos
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Jiménez-Mejías
authors.forename: Azucena
authors.initials: A
authors.lastname: Rodríguez-Guardado
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil
authors.forename: Juan M
authors.initials: JM
authors.lastname: García-Lechuz
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabellos
authors.forename: Fernando
authors.initials: F
authors.lastname: Chaves
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Elisa
authors.initials: E
authors.lastname: Pérez-Cecilia
authors.forename: Diego
authors.initials: D
authors.lastname: Domingo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents