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Staphylococcus aureus Meningitis: A Review of 104 Nationwide, Consecutive Cases

Staphylococcus aureus Meningitis: A Review of 104 Nationwide, Consecutive Cases Abstract Methods: Based on a nationwide registration, the clinical and bacteriologic data from 61 postoperative and 43 hematogenous cases of Staphylococcus aureus meningitis in Denmark from 1986 through 1989 were reviewed. Results: Postoperative meningitis was a foreign body infection in 89% of the cases and had a lower mortality (18% [11/61]) compared with hematogenous meningitis (56% [24/43]). Hematogenous S aureus meningitis seems to be part of an overwhelming, disseminated infection as indicated by the following: 81% of the patients had bacteremia, 21% had endocarditis, and 12% had osteomyelitis. Most patients were older, often with underlying diseases, community-acquired infections, and a clinical picture of severe meningitis. The major findings were mental status changes and a high rate (34%) of focal neurological changes. The initial leukocyte count in the cerebrospinal fluid sample was low, and the bacteria were seen in Gram's stain smears in 40% of cases only. The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis. Three (12%) of 25 surviving patients had severe sequelae. Conclusions: Hematogenous S aureus meningitis is a severe disease with a high mortality related to age, presence of shock, and infection with strains of phage type 95.(Arch Intern Med. 1993;153:1902-1908) References 1. Studdert TC. Staphylococcal spinal meningitis . BMJ . 1958;1:1457-1459.Crossref 2. Hyland HH. Modern experience in bacterial meningitis . Can Med Assoc J. 1959; 81:883-885. 3. Eigler JOC, Wellman WE, Rooke ED, Keith HM, Svien HJ. Bacterial meningitis, I: general review (294 cases) . Mayo Clin Proc. 1961;36:357-365. 4. Carpenter RR, Petersdorf RG. The clinical spectrum of bacterial meningitis . Am J Med. 1962;33:262-275.Crossref 5. Quaade F, Kristensen KP. Purulent meningitis: a review of 658 cases . Acta Med Scand. 1962;171:543-551.Crossref 6. Jonsson M, Alvin A. A 12-year review of acute bacterial meningitis in Stockholm . Scand J Infect Dis. 1971;3:141-150. 7. Fraser DW, Henke CE, Feldman RA. Changing patterns of bacterial meningitis in Olmsted County, Minnesota, 1935-1970 . J Infect Dis. 1973;128:300-307.Crossref 8. Floyd RF, Federspiel CF, Schaffner W. Bacterial meningitis in urban and rural Tennessee . Am J Epidemiol. 1974;99:395-407. 9. Hodges GR, Perkins RL. Acute bacterial meningitis: an analysis of factors influencing prognosis . Am J Med Sci. 1975;270:427-440.Crossref 10. Hodges GR, Perkins RL. Hospital-associated bacterial meningitis . Am J Med Sci. 1976;271:335-341.Crossref 11. Finland M, Barnes MW. Acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972 . J Infect Dis. 1977;136:400-415.Crossref 12. Geiseler PJ, Nelson KE, Levin S, Reddi KT, Moses VK. Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976 . Rev Infect Dis. 1980;2:725-745.Crossref 13. Bohr V, Hansen B, Jessen O, et al. Eight hundred and seventy-five cases of bacterial meningitis, I: clinical data, prognosis, and the role of specialized hospital departments . J Infect. 1983;7:21-30.Crossref 14. Kim JH, van der Horst C, Mulrow CD, Corey GR. Staphylococcus aureus meningitis: review of 28 cases . Rev Infect Dis. 1989;11:698-706.Crossref 15. Mulcare RJ, Harter DH. Changing patterns of staphylococcal meningitis . Arch Neurol. 1962;7:114-120.Crossref 16. Wellman WE, Senft RA. Bacterial meningitis, III: infections caused by Staphylococcus aureus . Mayo Clin Proc. 1964;39:263-269. 17. Roberts FJ, Smith JA, Wagner KR. Staphylococcus aureus meningitis: 26 years' experience at Vancouver General Hospital . Can Med Assoc J. 1983;128:1418-1420. 18. Fong IW, Ranalli P. Staphylococcus aureus meningitis . Q J Med. 1984;53:289-299. 19. Gordon JJ, Harter DH, Phair JP. Meningitis due to Staphylococcus aureus . Am J Med. 1985;78:965-970.Crossref 20. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad-based epidemiologic study . Medicine Baltimore . 1987;66:148-156. 21. Quintiliani R, Cooper BW. Current concepts in the treatment of staphylococcal meningitis . J Antimicrob Chemother. 1988;21( (suppl C) ):107-112.Crossref 22. Gardner P, Leipzig T, Philips P. Infections of central nervous system shunts . Med Clin North Am. 1985;69:297-231. 23. Tenney JH. Bacterial infections of the central nervous system in neurosurgery . Neurol Clin. 1986;4:91-114. 24. Schoenbaum SC, Gardner P, Shillito J. Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy . J Infect Dis. 1975;131:543-552.Crossref 25. George R, Leibrock L, Epstein M. Long-term analysis of cerebrospinal fluid shunt infections: a 25-year experience . J Neurosurg. 1979;51:804-811.Crossref 26. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection . Neurosurgery . 1980; 7:459-463.Crossref 27. Hemming VG, Overall JC Jr, Britt MR. Nosocomial infections in a newborn intensive care unit: results of forty-one months of surveillance . N Engl J Med. 1976;294:1310-1316.Crossref 28. Alfven G, Bergqvist G, Bolme P, Eriksson M. Long-term follow-up of neonatal septicemia . Acta Paediatr Scand. 1978;67:769-773.Crossref 29. Hieber JP, Nelson AJ, McCracken GH Jr. Acute disseminated staphylococcal disease in childhood . AJDC . 1977;131:181-185. 30. Jones HR Jr, Siekert RG, Geraci JE. Neurologic manifestations of bacterial endocarditis . Ann Intern Med. 1969;71:21-28.Crossref 31. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis . Medicine Baltimore . 1978;57:329-343. 32. Jessen O, Rosendal K, Bülow P, Faber V, Eriksen KR. Changing staphylocci and staphyloccal infections: a ten-year study of bacteria and cases of bacteremia . N Engl J Med. 1969;281:627-635.Crossref 33. Blair JE, Williams REO. Phage typing of staphylococci . Bull World Health Organ. 1961;24:771. 34. Parker MT. Phage-typing and the epidemiology of Staphylococcus aureus infection . J Appl Bacteriol. 1962;25:389.Crossref 35. Casals B, Pedersen OG. Tablet sensitivity testing: a comparison of different methods . Acta Pathol Microbiol Scand B. 1972;72:160-175. 36. Bayston R, Lari J. A study of the sources of infection in colonised shunts . Dev Med Child Neurol. 1974;16( (suppl 32) ):16-22.Crossref 37. Myers MG, Schoenbaum SC. Shunt fluid aspiration: an adjunct in the diagnosis of cerebrospinal fluid shunt infection . AJDC . 1975;129:220-222. 38. Rosendal K, Jessen O, Faber V, Bentzon MW. Frequency, phage types and antibiotic resistance of Staphylococcus aureus isolated from blood cultures in Denmark, 1975-1981 . Scand J Infect Dis Suppl. 1983;41:19-26. 39. Jensen K, Lassen HCA. Continued treatment with antibacterial chemotherapeutical agents in staphyloccal infections . Q J Med. 1969;38:91. 40. De Louvois J, Gortvai P, Hurley R. Antibiotic treatment of abscesses of the central nervous system . BMJ . 1977;2:985-987.Crossref 41. Gump DW. Vancomycin for treatment of bacterial meningitis . Rev Infect Dis. 1981;3( (suppl) ):S289-S292.Crossref 42. Sato K, Lin T-Y, Weintrub L, Olsen K, McCracken GH Jr. Bacteriological efficacy of nafcillin and vancomycin alone or combined with rifampicin or amikacin in experimental meningitis due to methicillin-susceptible or -resistant Staphylococcus aureus . Jpn J Antibiot. 1985;38:2155-2162. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Staphylococcus aureus Meningitis: A Review of 104 Nationwide, Consecutive Cases

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410160066005
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Abstract

Abstract Methods: Based on a nationwide registration, the clinical and bacteriologic data from 61 postoperative and 43 hematogenous cases of Staphylococcus aureus meningitis in Denmark from 1986 through 1989 were reviewed. Results: Postoperative meningitis was a foreign body infection in 89% of the cases and had a lower mortality (18% [11/61]) compared with hematogenous meningitis (56% [24/43]). Hematogenous S aureus meningitis seems to be part of an overwhelming, disseminated infection as indicated by the following: 81% of the patients had bacteremia, 21% had endocarditis, and 12% had osteomyelitis. Most patients were older, often with underlying diseases, community-acquired infections, and a clinical picture of severe meningitis. The major findings were mental status changes and a high rate (34%) of focal neurological changes. The initial leukocyte count in the cerebrospinal fluid sample was low, and the bacteria were seen in Gram's stain smears in 40% of cases only. The prognosis was related to the age of the patients and the initial antibiotic treatment. Patients treated with penicillinase-stable penicillins in combination with fusidic acid may have a better prognosis. Three (12%) of 25 surviving patients had severe sequelae. Conclusions: Hematogenous S aureus meningitis is a severe disease with a high mortality related to age, presence of shock, and infection with strains of phage type 95.(Arch Intern Med. 1993;153:1902-1908) References 1. Studdert TC. Staphylococcal spinal meningitis . BMJ . 1958;1:1457-1459.Crossref 2. Hyland HH. Modern experience in bacterial meningitis . Can Med Assoc J. 1959; 81:883-885. 3. Eigler JOC, Wellman WE, Rooke ED, Keith HM, Svien HJ. Bacterial meningitis, I: general review (294 cases) . Mayo Clin Proc. 1961;36:357-365. 4. Carpenter RR, Petersdorf RG. The clinical spectrum of bacterial meningitis . Am J Med. 1962;33:262-275.Crossref 5. Quaade F, Kristensen KP. Purulent meningitis: a review of 658 cases . Acta Med Scand. 1962;171:543-551.Crossref 6. Jonsson M, Alvin A. A 12-year review of acute bacterial meningitis in Stockholm . Scand J Infect Dis. 1971;3:141-150. 7. Fraser DW, Henke CE, Feldman RA. Changing patterns of bacterial meningitis in Olmsted County, Minnesota, 1935-1970 . J Infect Dis. 1973;128:300-307.Crossref 8. Floyd RF, Federspiel CF, Schaffner W. Bacterial meningitis in urban and rural Tennessee . Am J Epidemiol. 1974;99:395-407. 9. Hodges GR, Perkins RL. Acute bacterial meningitis: an analysis of factors influencing prognosis . Am J Med Sci. 1975;270:427-440.Crossref 10. Hodges GR, Perkins RL. Hospital-associated bacterial meningitis . Am J Med Sci. 1976;271:335-341.Crossref 11. Finland M, Barnes MW. Acute bacterial meningitis at Boston City Hospital during 12 selected years, 1935-1972 . J Infect Dis. 1977;136:400-415.Crossref 12. Geiseler PJ, Nelson KE, Levin S, Reddi KT, Moses VK. Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976 . Rev Infect Dis. 1980;2:725-745.Crossref 13. Bohr V, Hansen B, Jessen O, et al. Eight hundred and seventy-five cases of bacterial meningitis, I: clinical data, prognosis, and the role of specialized hospital departments . J Infect. 1983;7:21-30.Crossref 14. Kim JH, van der Horst C, Mulrow CD, Corey GR. Staphylococcus aureus meningitis: review of 28 cases . Rev Infect Dis. 1989;11:698-706.Crossref 15. Mulcare RJ, Harter DH. Changing patterns of staphylococcal meningitis . Arch Neurol. 1962;7:114-120.Crossref 16. Wellman WE, Senft RA. Bacterial meningitis, III: infections caused by Staphylococcus aureus . Mayo Clin Proc. 1964;39:263-269. 17. Roberts FJ, Smith JA, Wagner KR. Staphylococcus aureus meningitis: 26 years' experience at Vancouver General Hospital . Can Med Assoc J. 1983;128:1418-1420. 18. Fong IW, Ranalli P. Staphylococcus aureus meningitis . Q J Med. 1984;53:289-299. 19. Gordon JJ, Harter DH, Phair JP. Meningitis due to Staphylococcus aureus . Am J Med. 1985;78:965-970.Crossref 20. Schlesinger LS, Ross SC, Schaberg DR. Staphylococcus aureus meningitis: a broad-based epidemiologic study . Medicine Baltimore . 1987;66:148-156. 21. Quintiliani R, Cooper BW. Current concepts in the treatment of staphylococcal meningitis . J Antimicrob Chemother. 1988;21( (suppl C) ):107-112.Crossref 22. Gardner P, Leipzig T, Philips P. Infections of central nervous system shunts . Med Clin North Am. 1985;69:297-231. 23. Tenney JH. Bacterial infections of the central nervous system in neurosurgery . Neurol Clin. 1986;4:91-114. 24. Schoenbaum SC, Gardner P, Shillito J. Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy . J Infect Dis. 1975;131:543-552.Crossref 25. George R, Leibrock L, Epstein M. Long-term analysis of cerebrospinal fluid shunt infections: a 25-year experience . J Neurosurg. 1979;51:804-811.Crossref 26. James HE, Walsh JW, Wilson HD, Connor JD, Bean JR, Tibbs PA. Prospective randomized study of therapy in cerebrospinal fluid shunt infection . Neurosurgery . 1980; 7:459-463.Crossref 27. Hemming VG, Overall JC Jr, Britt MR. Nosocomial infections in a newborn intensive care unit: results of forty-one months of surveillance . N Engl J Med. 1976;294:1310-1316.Crossref 28. Alfven G, Bergqvist G, Bolme P, Eriksson M. Long-term follow-up of neonatal septicemia . Acta Paediatr Scand. 1978;67:769-773.Crossref 29. Hieber JP, Nelson AJ, McCracken GH Jr. Acute disseminated staphylococcal disease in childhood . AJDC . 1977;131:181-185. 30. Jones HR Jr, Siekert RG, Geraci JE. Neurologic manifestations of bacterial endocarditis . Ann Intern Med. 1969;71:21-28.Crossref 31. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis . Medicine Baltimore . 1978;57:329-343. 32. Jessen O, Rosendal K, Bülow P, Faber V, Eriksen KR. Changing staphylocci and staphyloccal infections: a ten-year study of bacteria and cases of bacteremia . N Engl J Med. 1969;281:627-635.Crossref 33. Blair JE, Williams REO. Phage typing of staphylococci . Bull World Health Organ. 1961;24:771. 34. Parker MT. Phage-typing and the epidemiology of Staphylococcus aureus infection . J Appl Bacteriol. 1962;25:389.Crossref 35. Casals B, Pedersen OG. Tablet sensitivity testing: a comparison of different methods . Acta Pathol Microbiol Scand B. 1972;72:160-175. 36. Bayston R, Lari J. A study of the sources of infection in colonised shunts . Dev Med Child Neurol. 1974;16( (suppl 32) ):16-22.Crossref 37. Myers MG, Schoenbaum SC. Shunt fluid aspiration: an adjunct in the diagnosis of cerebrospinal fluid shunt infection . AJDC . 1975;129:220-222. 38. Rosendal K, Jessen O, Faber V, Bentzon MW. Frequency, phage types and antibiotic resistance of Staphylococcus aureus isolated from blood cultures in Denmark, 1975-1981 . Scand J Infect Dis Suppl. 1983;41:19-26. 39. Jensen K, Lassen HCA. Continued treatment with antibacterial chemotherapeutical agents in staphyloccal infections . Q J Med. 1969;38:91. 40. De Louvois J, Gortvai P, Hurley R. Antibiotic treatment of abscesses of the central nervous system . BMJ . 1977;2:985-987.Crossref 41. Gump DW. Vancomycin for treatment of bacterial meningitis . Rev Infect Dis. 1981;3( (suppl) ):S289-S292.Crossref 42. Sato K, Lin T-Y, Weintrub L, Olsen K, McCracken GH Jr. Bacteriological efficacy of nafcillin and vancomycin alone or combined with rifampicin or amikacin in experimental meningitis due to methicillin-susceptible or -resistant Staphylococcus aureus . Jpn J Antibiot. 1985;38:2155-2162.

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 23, 1993

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