Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland
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 da...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-07999-2 |
| _version_ | 1811175950760542208 |
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| author | Sakke Niemelä Laura Lempinen Eliisa Löyttyniemi Jarmo Oksi Jussi Jero |
| author_facet | Sakke Niemelä Laura Lempinen Eliisa Löyttyniemi Jarmo Oksi Jussi Jero |
| author_sort | Sakke Niemelä |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T19:45:24Z |
| format | Article |
| id | doaj.art-95012b27c59c4902ba9eaf0971ccb997 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-10T19:45:24Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-95012b27c59c4902ba9eaf0971ccb9972023-01-29T12:05:27ZengBMCBMC Infectious Diseases1471-23342023-01-0123111010.1186/s12879-023-07999-2Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, FinlandSakke Niemelä0Laura Lempinen1Eliisa Löyttyniemi2Jarmo Oksi3Jussi Jero4Department of Otorhinolaryngology, Turku University Hospital and University of TurkuDepartment of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of HelsinkiUnit of Biostatistics, Department of Clinical Medicine, University of TurkuDepartment of Infectious Diseases, Turku University Hospital and University of TurkuDepartment of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of HelsinkiAbstract 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.https://doi.org/10.1186/s12879-023-07999-2Bacterial meningitisAdultsNosocomialGlasgow Outcome Scale |
| spellingShingle | Sakke Niemelä Laura Lempinen Eliisa Löyttyniemi Jarmo Oksi Jussi Jero Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland BMC Infectious Diseases Bacterial meningitis Adults Nosocomial Glasgow Outcome Scale |
| title | Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland |
| title_full | Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland |
| title_fullStr | Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland |
| title_full_unstemmed | Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland |
| title_short | Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland |
| title_sort | bacterial meningitis in adults a retrospective study among 148 patients in an 8 year period in a university hospital finland |
| topic | Bacterial meningitis Adults Nosocomial Glasgow Outcome Scale |
| url | https://doi.org/10.1186/s12879-023-07999-2 |
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