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Staphylococcus aureus meningitis. A review of 104 nationwide, consecutive cases
A G Jensen1, F Espersen, P Skinhøj
1Department of Clinical Microbiology, Bispebjerg Hospital, Copenhagen, Denmark.
Methods:
Based on a nationwide registration, the clinical and bacteriologic data from 61 postoperative and 43 hematogenous cases of Staphylococcus aureus meningitis in Denmark from 1986 through 1989 were reviewed.
Results:
Postoperative meningitis was a foreign body infection in 89% of the cases and had a lower mortality (18% [11/61]) compared with hematogenous meningitis (56% [24/43]). Hematogenous S aureus meningitis seems to be part of an overwhelming, disseminated infection as indicated by the following: 81% of the patients had bacteremia, 21% had endocarditis, and 12% had osteomyelitis. Most patients were older, often with underlying diseases, community-acquired infections, and a clinical picture of severe meningitis. The major findings were mental status changes and a high rate (34%) of focal neurological changes. The initial leukocyte count in the cerebrospinal fluid sample was low, and the bacteria were seen in Gram's stain smears in 40% of cases only. The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis. Three (12%) of 25 surviving patients had severe sequelae.
Conclusions:
Hematogenous S aureus meningitis is a severe disease with a high mortality related to age, presence of shock, and infection with strains of phage type 95.
Insights
Hematogenous Staphylococcus aureus meningitis is a severe infection with high mortality, often linked to underlying conditions and specific bacterial strains. Postoperative meningitis has a significantly lower mortality rate.
Area of Science:
- Infectious Diseases
- Bacteriology
- Neurology
Background:
- Staphylococcus aureus meningitis presents distinct challenges based on its origin.
- Understanding the differences between postoperative and hematogenous meningitis is crucial for patient outcomes.
Purpose of the Study:
- To analyze and compare clinical and bacteriologic data of postoperative versus hematogenous Staphylococcus aureus meningitis.
- To identify factors influencing mortality and prognosis in S. aureus meningitis.
Main Methods:
- Retrospective review of nationwide registration data.
- Analysis of 61 postoperative and 43 hematogenous S. aureus meningitis cases from 1986-1989 in Denmark.
Main Results:
- Hematogenous meningitis had higher mortality (56%) than postoperative (18%), often associated with disseminated infection (bacteremia, endocarditis).
- Patients with hematogenous meningitis were older, had more comorbidities, and presented with severe symptoms including neurological changes.
- Initial cerebrospinal fluid findings were often non-specific; prognosis correlated with age and antibiotic choice.
Conclusions:
- Hematogenous S. aureus meningitis is a severe condition with high mortality, influenced by patient age, shock, and specific phage types.
- Postoperative meningitis, often a foreign body infection, carries a better prognosis.