Adults with meningitis caused by oxacillin-resistant Staphylococcus aureus

Area of Science:

• Infectious Diseases
• Neuroscience
• Clinical Microbiology

Background:

• Oxacillin-resistant Staphylococcus aureus (ORSA) meningitis is an uncommon but increasingly recognized complication in adult patients.
• A postneurosurgical state is a significant underlying condition, with fever and altered consciousness being common clinical signs.

Purpose of the Study:

• To analyze the clinical characteristics, management, and outcomes of adult patients with ORSA meningitis.
• To evaluate the effectiveness of vancomycin in treating ORSA meningitis and provide insights for empirical antibiotic selection.

Main Methods:

• Retrospective review of 11 adult patients diagnosed with ORSA meningitis between 1995 and the present.
• Analysis of patient demographics, clinical manifestations, causative pathogens, treatment regimens (primarily intravenous vancomycin), and mortality.

Main Results:

• All 11 patients had a postneurosurgical state; 8 had S. aureus only, and 3 had mixed infections.
• Four out of 8 patients treated with vancomycin for S. aureus meningitis died, indicating a high mortality rate.
• Diagnosis relies on positive cerebrospinal fluid cultures, necessitating institutional data for empirical antibiotic choices.

Conclusions:

• ORSA meningitis, though rare, is a serious condition with increasing incidence in adults.
• Intravenous vancomycin appears to be a viable treatment option for adult ORSA meningitis, despite significant associated mortality.
• Empirical antibiotic strategies should consider local pathogen prevalence and resistance patterns.