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. 2023 Jan 23;23(1):45.
doi: 10.1186/s12879-023-07999-2.

Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland

Sakke Niemelä  1 , Laura Lempinen  2 , Eliisa Löyttyniemi  3 , Jarmo Oksi  4 , Jussi Jero  5
Affiliations

Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland

Sakke Niemelä et al. BMC Infect Dis. .

Abstract

Background: Bacterial meningitis (BM) causes significant morbidity and mortality. We investigated predisposing factors, clinical characteristics, spectrum of etiological bacteria, and clinical outcome of community-acquired and nosocomial BM.

Methods: In this retrospective study we analyzed data of 148 adults (age > 16 years) with BM treated in Turku University Hospital, Southwestern Finland, from 2011 to 2018. Besides culture- or polymerase chain reaction (PCR)-positive cases we also included culture-negative cases with laboratory parameters strongly suggestive of BM and those with meningitis-related findings in imaging. We used Glasgow Outcome Scale (GOS) score 1-4 to determine unfavorable outcome.

Results: The median age of patients was 57 years and 48.6% were male. Cerebrospinal fluid (CSF) culture for bacteria showed positivity in 50 (33.8%) cases, although pre-diagnostic antibiotic use was frequent (85, 57.4%). The most common pathogens in CSF culture were Streptococcus pneumoniae (11, 7.4%), Staphylococcus epidermidis (7, 4.7%), Staphylococcus aureus (6, 4.1%) and Neisseria meningitidis (6, 4.1%). Thirty-nine patients (26.4%) presented with the triad of fever, headache, and neck stiffness. A neurosurgical procedure or an acute cerebral incident prior BM was recorded in 74 patients (50%). Most of the patients had nosocomial BM (82, 55.4%) and the rest (66, 44.6%) community-acquired BM. Ceftriaxone and vancomycin were the most used antibiotics. Causative pathogens had resistances against the following antibiotics: cefuroxime with a frequency of 6.8%, ampicillin (6.1%), and tetracycline (6.1%). The case fatality rate was 8.8% and the additional likelihood of unfavorable outcome 40.5%. Headache, decreased general condition, head computed tomography (CT) and magnetic resonance imaging (MRI), hypertension, altered mental status, confusion, operative treatment, neurological symptoms, pre-diagnostic antibiotic use and oral antibiotics on discharge were associated with unfavorable outcome.

Conclusions: The number of cases with nosocomial BM was surprisingly high and should be further investigated. The usage of pre-diagnostic antibiotics was also quite high. Headache was associated with unfavorable outcome. The frequency of unfavorable outcome of BM was 40.5%, although mortality in our patients was lower than in most previous studies.

Keywords: Adults; Bacterial meningitis; Glasgow Outcome Scale; Nosocomial.

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Conflict of interest statement

J.O reports receiving compensations for lectures or advisory boards outside the submitted work from AstraZeneca, Biocodex, Gilead, GlaxoSmithKline, MSD-Finland, Orion, Pfizer, Roche, Rokotustutkimuskeskus, and for congress travel from UnimedicPharma. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
A Incidence of bacterial meningitis. B Bacteria cultured from CSF by year of meningitis. Panel C. Bacteria from CSF culture by age groups
Fig. 2
Fig. 2
A Antibiotic resistant bacterium species cultured from CSF. B Quantity of patients with antibiotics used intravenously after the diagnosis of bacterial meningitis
See this image and copyright information in PMC

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