Acute bacterial meningitis in adults. A review of 493 episodes.

Authors

Durand ML, Calderwood SB, Weber DJ, et al. 

Institution

Infectious Disease Unit, Massachusetts General Hospital, Boston 02114.

Source

N Engl J Med 1993 Jan 7; 328(1) :21-8.

Abstract

BACKGROUND AND METHODS
To characterize acute bacterial meningitis in adults, we reviewed the charts of all persons 16 years of age or older in whom acute bacterial meningitis was diagnosed at Massachusetts General Hospital from 1962 through 1988. We included patients who were admitted after initial treatment at other hospitals.
RESULTS
During the 27-year period, 445 adults were treated for 493 episodes of acute bacterial meningitis, of which 197 (40 percent) were nosocomial. Gram-negative bacilli (other than Haemophilus influenzae) caused 33 percent of the nosocomial episodes but only 3 percent of the community-acquired episodes. In the 296 episodes of community-acquired meningitis, the most common pathogens were Streptococcus pneumoniae (37 percent), Neisseria meningitidis (13 percent), and Listeria monocytogenes (10 percent); these organisms accounted for only 8 percent of the nosocomial episodes. Only 19 of the 493 episodes of meningitis (4 percent) were due to H. influenzae. Nine percent of all patients had recurrent meningitis; many had a cerebrospinal fluid leak. Seizures occurred in 23 percent of patients with community-acquired meningitis, and 28 percent had focal central nervous system findings. Risk factors for death among those with single episodes of community-acquired meningitis included older age (> or = 60 years), obtunded mental state on admission, and seizures within the first 24 hours. Among those with single episodes, the in-hospital mortality rate was 25 percent for community-acquired and 35 percent for nosocomial meningitis. The overall case fatality rate was 25 percent and did not vary significantly over the 27 years.
CONCLUSIONS
In our large urban hospital, a major proportion of cases of acute bacterial meningitis in adults were nosocomial. Recurrent episodes of meningitis were frequent. The overall mortality rate remained high.

Mesh

Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Boston
Cross Infection
Gram-Negative Bacterial Infections
Hospital Mortality
Humans
Meningitis, Bacterial
Middle Aged
Pneumococcal Infections
Recurrence
Risk Factors
Seizures

Language

eng

Pub Type(s)

Journal Article

PubMed ID

8416268