title: Mixed infection in adult post-neurosurgical bacterial meningitis: a hospital-based study.
abstract: BACKGROUND
  Post-neurosurgical (post-NS) adult bacterial meningitis (ABM) with mixed infection is rarely examined solely in the literature.
  
  
  METHODS
  The clinical features and laboratory data of post-NS ABM patients with mixed infection were included for analysis.
  
  
  RESULTS
  Totally 170 post-NS ABM cases were identified and 18 (11 men and 7 women, aged 20-77 years, median = 57.5) of them had a mixed infection. A total of 45 bacterial strains including 34 Gram-negative [Gm(-)] strains and 11 Gram-positive [Gm(+)] strains were isolated. Of the implicated pathogens, Escherichia coli, Acinetobacter, Pseudomonas, and Klebsiella spp. were the common Gm(-) strains, while staphylococcal, streptococcal, and enterococcal strains were the common Gm(+) strains. Compared with the post-NS ABM cases with monomicrobial infection, those with mixed infection had a lower cerebrospinal fluid (CSF) white blood cell count. The mortality rate of post-NS ABM cases was 33.3% (6/18) without significant clinical and laboratory difference between the fatal and non-fatal groups.
  
  
  CONCLUSIONS
  Mixed infection is not uncommon in post-NS ABM (10.6%, 18/170), and its mortality rate is high. Seventy-six percent of the implicated bacterial pathogens belonged to Gm(-) strains, while the other 24% were Gm(+) strains. The clinical and laboratory features of ABM with mixed infection are not unique; its diagnosis can only be confirmed by a positive CSF culture.
authors.forename: Wei-An
authors.initials: WA
authors.lastname: Lai
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Department of Family Medicine and Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D060085:Coinfection / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D008875:Middle Aged; D011379:Prognosis