Community-acquired acute bacterial meningitis in the elderly in Turkey

Abstract

This investigation aimed both to delineate the current status of community-acquired acute bacterial meningitis and to produce data on the interrelationships between clinical, laboratory and therapeutic parameters in the elderly. This retrospective cohort study was conducted in 28 Turkish institutions in 159 culture-positive patients over the age of 50 years. Streptococcus pneumoniae was the most common pathogen (69.2%), followed by Listeria monocytogenes (8.8%). For this reason, antilisterial antibiotics such as ampicillin or benzylpenicillin should be added to the therapeutic regimen. Pathogen-specific mortality did not vary between S. pneumoniae and L. monocytogenes. The overall mortality was 2.5% at the third day, 12.6% at the seventh day, 20.1% at the 14th day and 21.4% at the 21st day. The risk factors for fatality were increasing age, the presence of stupor, sepsis and inappropriate antibiotic administration. Cerebrospinal fluid (CSF) leukocyte counts and CSF/blood glucose ratios were lower in patients who died. Fever did not differ between survivors and fatal cases. The mean duration of antibiotic therapy in survivors was 16.3 +/- 6.4 days. One-fifth of the patients had complications, and in 5.7% of the patients sequelae persisted at follow-up.

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

“…On the other hand, the data in the literature related to the efficacy of treatment in HSV-2 meningitis are rather unclear (25,26).The host parameters directly affect the course of central nervous system (CNS) infections. In different types of CNS infections, increasing age and lower GCS scores have long been known to be associated with poor outcomes (27)(28)(29). Our HME data were also in accordance with those regarding other infectious CNS disorders and with the initial reports of adult HME series (10,18,19).…”

Sepsis and Other Infectious Disease Emergencies in the Elderly

“…110–115 Predisposing conditions such as otitis, sinusitis, or pneumonia may be present and sepsis may complicate up to a third of cases. 112,114–116 Elders may have fever, headache, or neck stiffness, but more commonly exhibit altered mental status, seizure, stupor, or coma. 111–117 Abnormal neurological findings are often present, including focal motor deficits, cranial nerve abnormalities, and aphasia.…”

Clinical characteristics and prognosis of acute bacterial meningitis in elderly patients over 65: a hospital-based study

“…The study of bacterial meningitis with a focus only on elderly patients has rarely been solely examined in the related literature [2-4]. In the United States, because of the success of conjugate vaccines in reducing the risk of major pathogens-related meningitis among young children, the burden of bacterial meningitis is now borne more by older patients [5].…”

“…Furthermore, the epidemiologic change of implicated pathogens may influence the early choice of appropriate, empiric antibiotics which is important for the successful treatment of adult bacterial meningitis (ABM) [1,6,7]. Elderly patients with bacterial meningitis are known to have a grave prognosis [3,4]. Therefore, in this study, we analyzed the clinical and laboratory characteristics and the therapeutic outcome of 87 elderly ABM patients and also made a clinical comparison with those of with bacterial meningitis in a non-elderly group.…”