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Nosocomial bacterial meningitis in adults: a prospective series of 50 cases

M Weisfelt1, D van de Beek, L Spanjaard

  • 1Center of Infection and Immunity Amsterdam, Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands. m.weisfelt@amc.uva.nl

The Journal of Hospital Infection
|April 17, 2007
PubMed

Insights

Nosocomial meningitis in adults often presents with classic symptoms but may lack consciousness impairment. Underlying conditions are common, with specific pathogens like Staphylococcus aureus and Streptococcus pneumoniae identified, leading to high complication and mortality rates.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Critical Care Medicine

Background:

  • Nosocomial meningitis, acquired during healthcare, presents unique challenges in adult patients.
  • Understanding the specific characteristics and risk factors of hospital-acquired meningitis is crucial for effective management.

Purpose of the Study:

  • To evaluate the clinical characteristics of nosocomial bacterial meningitis in adult patients.
  • To identify common pathogens and associated underlying conditions in hospital-acquired meningitis.
  • To determine complication rates and mortality associated with nosocomial meningitis.

Main Methods:

  • Prospective cohort study involving 50 episodes of nosocomial bacterial meningitis in patients over 16 years old.
  • Confirmation of meningitis through cerebrospinal fluid (CSF) culture.
  • Analysis of clinical presentation, underlying conditions, pathogens, and outcomes.

Main Results:

  • Classic meningitis symptoms (headache, neck stiffness, fever) were present in over 70% of cases; consciousness impairment occurred in 41%.
  • Ninety-four percent of patients had underlying conditions, including neurosurgery history, head injury, or CSF leakage.
  • Staphylococcus aureus was common in post-neurosurgery patients (31%), while Streptococcus pneumoniae was more frequent with distant infections (67%).
  • Complications occurred in 50% of episodes, with a 16% mortality rate.

Conclusions:

  • Adult nosocomial meningitis is distinct from community-acquired forms, with specific pathogens and high morbidity/mortality.
  • Underlying conditions, particularly neurosurgery history and distant infections, are significant risk factors.
  • Early recognition and targeted treatment are essential given the high complication and mortality rates.

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