Acute bacterial meningitis in adults. A 12-year review

Medicine (Baltimore). 2000 Nov;79(6):360-8. doi: 10.1097/00005792-200011000-00002.

Abstract

One hundred three episodes of acute bacterial meningitis in adults hospitalized in Edmonton's 2 largest hospitals from 1985 to 1996 were reviewed. Cases complicating neurosurgery were excluded. Most cases were community-acquired (87%). Twenty-three cases remained culture-negative, and there was no statistical relation between culture negativity and antibiotic pretreatment. Streptococcus pneumoniae was the predominant pathogen (52.5%), but Listeria monocytogenes was the second most common isolate, accounting for 12.5% of culture-positive cases. Compared to non-listerial meningitis, those with listeriosis were more likely to have negative cerebrospinal fluid (CSF) Gram stains (p = 0.07), CSF leukocyte counts < 1,000 cells/mm3 (p < 0.003), and normal CSF glucose (p = 0.006). Bacterial antigen detection was found to be of low sensitivity: 33% in all patients, but only 9% in cases with negative CSF Gram stains. The overall mortality was 18%, with 15 deaths directly attributable to acute meningitis; the case-fatality rates for S. pneumoniae and L. monocytogenes were 24% and 40%, respectively. Mortality was significantly higher among those with seizures (34% versus 7%, respectively; p < 0.001; OR = 17.6). Despite the urgency of acute bacterial meningitis, there were considerable delays in the institution of empiric antibiotics; mortality rates were slightly higher in those who experienced such a delay (16% versus 7% respectively; p = 0.18).

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Alberta / epidemiology
  • Anti-Bacterial Agents / therapeutic use
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / etiology
  • Cross Infection / diagnosis
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Immunocompromised Host
  • Incidence
  • Male
  • Meningitis, Bacterial / diagnosis
  • Meningitis, Bacterial / drug therapy
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / etiology
  • Middle Aged
  • Population Surveillance
  • Retrospective Studies
  • Sex Distribution
  • Splenectomy / adverse effects

Substances

  • Anti-Bacterial Agents