[Bacterial meningitis in Denmark 2002-2003. A nation-wide laboratory-based registration]

Notification of bacterial meningitis (BM) is likely to be incomplete, and a recent Danish study indicated that unbalanced notification may bias expected aetiology of BM. Therefore the Danish Bacterial Meningitis Group initiated a national registration of culture-positive BM.

Laboratory data on all bacterial isolates from cerebrospinal fluid deemed to be clinically relevant were identified on a national basis during 2002 and 2003. Bacterial findings were compared to cases notified during the same period.

A total of 404 BM cases were identified. The distribution of bacterial species differed from the national notification data during the same period especially with respect to Staphylococcus aureus (6.7% vs. 0.6%), Escherichia coli (3.5% vs. 0%) and non-Streptococcus pneumoniae streptococci (10% vs. 1.9%). The overall notification-rate was 66%, and was below 20% for S. aureus, E. coli, Enterococcus faecalis, non-S. pneumoniae streptococci and for 13 cases of "other bacteria". Sensitivity to antibiotics in the BM cases was as expected for Northern Europe. Reduced sensitivity to penicillin was found in 2/202 S. pneumoniae, in 2/10 Listeria monocytogenes, and 21/27 S. aureus were penicillin resistant. E. coli was resistant to ampicillin in 5 of 13 cases and to gentamicin in 1 of 11 cases.

A suboptimal notification rate with an unbalanced species distribution was found. Laboratory based data thus constitute an improved basis for future recommendations for empirical treatment of BM. A continued national collaboration may promote the development of quality indicators for diagnosis and initial treatment of BM.