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Coagulase-negative staphylococcal meningitis in adults: clinical characteristics and therapeutic outcomes

C-R Huang1, C-H Lu, J-J Wu

  • 1Dept. of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung County, 833, Taiwan.

Infection
|April 14, 2005
PubMed
Abstract

Insights

Coagulase-negative staphylococci (CoNS) meningitis in adults often occurs after neurosurgery and is typically caused by Staphylococcus epidermidis. Vancomycin treatment and device removal lead to a high survival rate for this serious infection.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Clinical Microbiology

Background:

  • Coagulase-negative staphylococci (CoNS) are an increasingly recognized cause of meningitis.
  • Adult meningitis cases caused by CoNS require detailed analysis of clinical features and treatment outcomes.

Purpose of the Study:

  • To analyze the clinical characteristics and therapeutic outcomes of adult meningitis caused by CoNS.
  • To identify the common CoNS subtypes and their antibiotic resistance patterns.

Main Methods:

  • Retrospective analysis of 14 adult culture-proven CoNS meningitis cases over a 5-year period.
  • Clinical data collection including patient demographics, underlying conditions, clinical manifestations, and treatment strategies.
  • Bacterial identification using 16S rRNA gene sequencing and detection of the mecA gene for antibiotic resistance.

Main Results:

  • CoNS meningitis represented 11% of adult bacterial meningitis cases.
  • All patients had a disrupted central nervous system barrier, primarily post-neurosurgery with device placement; 12/14 infections were nosocomial.
  • Staphylococcus epidermidis was the most common pathogen (10/14), and all strains were oxacillin-resistant but sensitive to vancomycin and linezolid.
  • Clinical signs included fever (86%), leukocytosis (79%), and consciousness disturbance (36%).
  • Treatment involving device removal and vancomycin resulted in an 86% survival rate (12/14), with a 14% mortality rate (2/14).

Conclusions:

  • CoNS meningitis is a significant complication in adult neurosurgical patients with breached central nervous system barriers.
  • Staphylococcus epidermidis is the predominant CoNS species causing meningitis in this population.
  • Effective management includes prompt diagnosis, removal of neurosurgical devices, and appropriate antibiotic therapy, such as vancomycin, leading to favorable outcomes.

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