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. 2022 Jul;70(7):2060-2069.
doi: 10.1111/jgs.17766. Epub 2022 Mar 29.

Community-acquired bacterial meningitis in patients of 80 years and older

Thijs M van Soest  1 , Nora Chekrouni  1 , Nina M van Sorge  2   3 , Matthijs C Brouwer  1 , Diederik van de Beek  1
Affiliations

Community-acquired bacterial meningitis in patients of 80 years and older

Thijs M van Soest et al. J Am Geriatr Soc. 2022 Jul.

Abstract

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.

Keywords: clinical characteristics; community-acquired bacterial meningitis; pathogens; prospective cohort study; very old patients.

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Conflict of interest statement

Nina M. van Sorge receives consultancy fees from Pfizer, MSD, and GSK (fees paid to Amsterdam UMC); In addition, Nina M. van Sorge has a patent WO 2013/020090 A3 (inventors: N.M. van Sorge/V. Nizet) outside the submitted work with royalties paid to University of California San Diego. Other authors: no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient inclusion. Out of 2306 patients prospectively included in the MeninGene study, 2177 episodes met the inclusion criteria for the present study, of which 37 had 1 or more exclusion criteria. One hundred and forty‐nine of 2140 episodes were in patients aged 80 years or older
FIGURE 2
FIGURE 2
Distribution of the cause of death within age groups. Figure displaying the percentage of patients within the age groups of 80 years or older and 16–79 years old (y‐axis), dying due to specific causes of death (x‐axis). Patients aged 80 years or older most commonly died due to cardiorespiratory failure while younger patients most commonly died due to brain herniation
See this image and copyright information in PMC

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