Spontaneous gram-negative bacillary meningitis in adult patients: characteristics and outcome

Abstract

BackgroundSpontaneous meningitis caused by gram-negative bacilli in adult patients is uncommon and poorly characterized. Our objective is to describe and compare the characteristics and the outcome of adult patients with spontaneous gram-negative bacilli meningitis (GNBM) and spontaneous meningitis due to other pathogens.MethodsProspective single hospital-based observational cohort study conducted between 1982 and 2006 in a university tertiary hospital in Barcelona (Spain). The Main Outcome Measure: In-hospital mortality.ResultsGram-negative bacilli meningitis was diagnosed in 40 (7%) of 544 episodes of spontaneous acute bacterial meningitis. The most common pathogens were Escherichia coli and Pseudomonas species. On admission, characteristics associated with spontaneous gram-negative bacilli meningitis by multivariate modeling were advanced age, history of cancer, nosocomial acquisition of infection, urinary tract infection as distant focus of infection, absence of rash, hypotension, and a high cerebrospinal fluid white-cell count. Nine (23%) episodes were acquired in the hospital and they were most commonly caused by Pseudomonas. The in-hospital mortality rate was 53%. The mortality rate was higher among patients with Gram-negative bacillary meningitis than among those with other bacterial meningitis and their risk of death was twenty times higher than among patients infected with Neisseria meningitidis (odds ratio 20.47; 95% confidence interval 4.03-103.93; p<0.001).ConclusionsGram-negative bacilli cause 9% of spontaneous bacterial meningitis of known etiology in adults. Characteristics associated with GNBM include advanced age, history of cancer, nosocomial acquisition, and urinary tract infection as distant focus of infection. The mortality rate is higher among patients with gram-negative bacillary meningitis than among those with other bacterial meningitides.

Spontaneous adult Gram-negative bacillary meningitis in Soweto, South Africa

“…[2][3][4][5][6] The most striking finding was the disproportionate burden in patients with advanced HIV infection. In France, three (7.5%) of 40 patients with spontaneous GNB meningitis were HIV-infected.…”

“…In France, three (7.5%) of 40 patients with spontaneous GNB meningitis were HIV-infected. 6 In Gabon, all 16 patients with GNB meningitis (nine with E. coli and seven with Pseudomonas aeruginosa) were HIV-infected. 8 If GNB meningitis is caused by systemic bacteraemia, 2 the organisms should mirror those in the community.…”

“…11 The mortality was higher than the 38-61% in equivalent studies. [2][3][4][5][6] There were limitations to this study as it was a retrospective record review and was dependant on the adequacy of documentation provided by the attending practitioners. Unmeasured confounders may have impacted the results.…”

“…10 Except for fewer patients with documented fever than in some other reports, the clinical features of meningitis were similar to those published. [2][3][4][5][6] The choice of antibiotics for the treatment of GNB meningitis has become more difficult as resistance to cefotaxime and ceftriaxone has increased. 11 In eight of the 10 isolates resistant to cefotaxime and ceftriaxone in this series, nosocomial acquisition was a clue for meropenem treatment.…”

“…1 Spontaneous GNB meningitis, as distinct from neurosurgical GNB meningitis, is commonly community-acquired, is associated with underlying disease, particularly diabetes mellitus, alcoholism, malignancy and other immunocompromised states, and has a higher mortality. [2][3][4][5][6] This study was undertaken to describe adults with spontaneous GNB meningitis in Soweto, South Africa, an area with high HIV seroprevalence, and to compare those patients with HIV infection to the HIV-non-infected.…”