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[Comparative study of meningitis due to Staphylococcus aureus and coagulase-negative Staphylococci in adults]
P Laguna-Del Estal1, A Castañeda-Pastor, M Gil-Navarro
1Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España. pld02m@saludalia.com
Introduction:
Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they are a frequent cause of nosocomial meningitis. AIMS. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults.
Patients And Methods:
We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp.
Results:
Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoN Staphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent in infections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%).
Conclusions:
Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially in the post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus.
Insights
Staphylococcus aureus causes severe hospital-acquired meningitis with high mortality, unlike coagulase-negative Staphylococci. This study highlights the risks associated with neurosurgery and devices in Staphylococcus meningitis cases.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Critical Care Medicine
Background:
- Staphylococcus species are uncommon causes of community-acquired acute bacterial meningitis (ABM).
- These bacteria are a significant cause of nosocomial meningitis, particularly in hospital settings.
- This study focuses on adult ABM caused by Staphylococcus aureus and coagulase-negative (CoN) Staphylococci.
Purpose of the Study:
- To describe and compare cases of acute bacterial meningitis (ABM) caused by Staphylococcus aureus and coagulase-negative Staphylococci in adults.
- To identify risk factors and outcomes associated with these specific Staphylococcus-related meningitis cases.
Main Methods:
- Retrospective review of medical records for patients aged 14 years or older diagnosed with ABM.
- Inclusion criteria required a positive cerebrospinal fluid (CSF) culture for Staphylococcus species.
- Comparative analysis of clinical features, risk factors, and outcomes between S. aureus and CoN Staphylococci meningitis.
Main Results:
- Forty cases of Staphylococcus-induced ABM were identified, with 12 caused by S. aureus and 28 by CoN Staphylococci.
- The incidence of Staphylococcus meningitis increased over the study period, with most cases being nosocomial and post-operative, often linked to neurosurgical devices.
- S. aureus infections were associated with higher rates of bacteremia, complications, and a significantly higher mortality rate (67%) compared to CoN Staphylococci (0%).
Conclusions:
- Staphylococcus species are a notable cause of ABM in neurosurgical patients, especially post-operatively or with CSF devices.
- While CoN Staphylococci meningitis generally has a favorable prognosis, S. aureus meningitis carries a high mortality risk.
- Management strategies should consider the specific Staphylococcus species and associated risk factors, particularly in neurosurgical contexts.
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