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Community-acquired bacterial meningitis in patients of 80 years and older
Thijs M van Soest1, Nora Chekrouni1, Nina M van Sorge2,3
1Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Background:
Advanced age is a risk factor for unfavorable outcome in community-acquired bacterial meningitis, but clinical characteristics and outcome in meningitis patients of 80 years or older have not been defined.
Methods:
We compared clinical characteristics and outcome of community-acquired bacterial meningitis patients aged 80 years or older and adults under 80 years old within a prospective nationwide cohort study.
Results:
Out of 2140 episodes identified between March 2006 and July 2018, 149 occurred in patients aged 80 years or older (7%). Common predisposing factors other than age were diabetes mellitus (25 of 148 [17%]), otitis or sinusitis (30 of 136 [22%]), and pneumonia (23 of 141 [16%]). The triad of fever, neck stiffness and altered consciousness was present in 60 of 139 (43%). The most common causative pathogen was Streptococcus pneumoniae (99 of 149 [66%]). Atypical causative pathogens, such as Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli, occurred more often compared to younger patients (49 of 149 [33%] vs 362 of 1991 [18%]; p < 0.001). Patients of 80 years and older had high case fatality rate (75 of 149 [50%]), but 45 of 149 (30%) had a favorable outcome. Characteristics associated with an unfavorable outcome were absence of otitis or sinusitis, presence of aphasia, mono- or hemiparesis, a lower score on the Glasgow Coma Scale, a higher heart rate, a higher blood C-reactive protein concentration and CSF leukocytes <100 per mm3 .
Conclusions:
Bacterial meningitis in patients of 80 years of older is associated with high rates of unfavorable outcome and death. Atypical causative pathogens such as L. monocytogenes, S. aureus, and E. coli occur commonly and should be considered when starting empirical antimicrobial therapy in this age group.
Insights
Community-acquired bacterial meningitis in patients aged 80 and older has a high fatality rate. However, atypical pathogens like Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli are common and require consideration in treatment strategies.
Area of Science:
- Infectious Diseases
- Geriatrics
- Neurology
Background:
- Advanced age is a known risk factor for poor outcomes in community-acquired bacterial meningitis.
- However, specific clinical characteristics and outcomes for patients aged 80 years and older remain underexplored.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of community-acquired bacterial meningitis in patients aged 80 years and older versus those younger than 80.
- To identify factors associated with unfavorable outcomes in elderly meningitis patients.
Main Methods:
- A prospective nationwide cohort study was conducted.
- Clinical data from 2140 community-acquired bacterial meningitis episodes (March 2006-July 2018) were analyzed, with a focus on 149 patients aged 80 years and older.
Main Results:
- Patients aged 80+ (7% of cases) had a high case fatality rate (50%), though 30% experienced a favorable outcome.
- Atypical pathogens (Listeria monocytogenes, Staphylococcus aureus, Escherichia coli) were more frequent in older patients (33% vs. 18%).
- Unfavorable outcomes were linked to absence of otitis/sinusitis, aphasia, focal neurological deficits, lower Glasgow Coma Scale scores, and specific laboratory findings.
Conclusions:
- Bacterial meningitis in individuals aged 80 years and older is associated with significant mortality and morbidity.
- Empirical antimicrobial therapy in this demographic should consider the increased prevalence of atypical pathogens.
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