Bacterial meningitis

see Nosocomial bacterial meningitis.

The most common organisms causing meningitis were non-lactose fermenting Gram negative bacteria followed by Pseudomonas aeruginosa and Klebsiella species. 1).

Gram negative bacteria organisms are the most common causative pathogens of postoperative meningitis.

see Acinetobacter baumannii meningitis.

see Pneumococcal meningitis.

Stenotrophomonas maltophilia meningitis

Bacterial meningitis is a medical emergency needing quick and timely diagnosis.

Early neuro-intensive care using intracranial pressure ICP-targeted therapy, mainly cerebrospinal fluid drainage, reduces mortality and improves the overall outcome in adult patients with acute bacterial meningitis (ABM) and severely impaired mental status on admission 2).

Intracranial subdural empyema (SDE) and cerebrovascular accident (CVA) are uncommon life-threatening complications of bacterial meningitis, which require urgent evacuation to prevent adverse outcomes. Clinicians must be vigilant of the onset of focal neurologic deficits or seizure activity to establish the diagnosis of SDE 3).

Symptomatic chronic extra-axial fluid collections in children

Ten consecutive patients with severe streptococcus meningitis were included in a prospective cohort study from the Odense University Hospital. Intracranial pressure, brain tissue oxygen tension (PbtO2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO2 simultaneously monitored within the same cerebral region.

In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO2 decreased below 10 mm Hg and a correlation between LP and PbtO2 was observed.

This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation 4).

Yin et al. from the Department of Neurotrauma, General Hospital of Chinese People's Armed Police Force, No. 69 Yongding Road, Haidian District, Beijing, China, conducted a retrospective analysis of 46 patients who attended General Hospital of Chinese People's Armed Police Force in Beijing, China, from January 1, 2014 to April 30, 2016. The CSF leukocyte, polykaryocyte, protein and glucose had been tested when their antibiotic treatments were empirically stopped. Between the non-relapse and relapse groups, Wilcoxon Rank Sum test was used to compare the differences of CSF leukocyte and polykaryocyte, and t-test was applied to contrast the distinctions of CSF protein and glucose, then, the thresholds of significant items were estimated by ROC curve.

The CSF leukocyte counts in non-relapse group are 23.72 ± 14.12/mm3, which are statistically less than the relapse group's (47.00 ± 1.00/mm3, P = 0.014), so does the CSF polykaryocyte counts (1.74 ± 4.84/mm3 &4.67 ± 1.15/mm3, P = 0.012). Between the two groups, the AUCs of leucocyte and polykaryocyte are 0.926 (95% CI = 0.845-1.0, P = 0.014) and 0.884 (95%CI = 0.786-0.982, P = 0.028), respectively. Their critical values are 44/mm3 (sensitivity = 1, specificity = 0.907) and 3/mm3 (sensitivity = 1, specificity = 0.837). Conversely, CSF protein and glucose have no statistic differences between the two groups.

Both CSF leukocyte and polykaryocyte can satisfactorily indicate whether the post-neurosurgical bacterial meningitis has completely been cured, 0-44/mm3 is recommended as the reference range of CSF leukocyte, and the CSF polykaryocyte' s is 0-3/mm3 5).


A retrospective study was conducted at Hamad General Hospital between January 1, 2009, and December 31, 2013.

Khan et al. identified 117 episodes of acute bacterial meningitis in 110 patients. Their mean age was 26.4 ± 22.3 years (range: 2-74) and 81 (69.2%) of them were male patients. Fifty-nine episodes (50.4%) were community acquired infection and fever was the most frequent symptom (94%), whereas neurosurgery is the most common underlying condition. Coagulase-negative staphylococci were the most common causative agent, of which 95% were oxacillin-resistant, while 63.3% of Acinetobacter spp. showed resistance to meropenem. The in-Hospital mortality was 14 (12%). Only the presence of underlying diseases, hypotension, and inappropriate treatment were found to be independent predictors of mortality.

Acute bacterial meningitis predominantly affected adults and Coagulase negative staphylococcus species were the common causative agent in Qatar with majority Nosocomial infections. More than 90% of all implicated coagulase-negative staphylococci strains were oxacillin-resistant 6).

Srinivas D, Veena Kumari HB, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: an institutional experience. Neurol India. 2011 Mar-Apr;59(2):195-8. doi: 10.4103/0028-3886.79136. PubMed PMID: 21483116.
Glimåker M, Johansson B, Halldorsdottir H, Wanecek M, Elmi-Terander A, Ghatan PH, Lindquist L, Bellander BM. Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention-control study. PLoS One. 2014 Mar 25;9(3):e91976. doi: 10.1371/journal.pone.0091976. eCollection 2014. PubMed PMID: 24667767; PubMed Central PMCID: PMC3965390.
Dakkak M, Cullinane WR Jr, Ramoutar VR. Subdural Empyema Complicating Bacterial Meningitis: A Challenging Diagnosis in a Patient with Polysubstance Abuse. Case Rep Med. 2015;2015:931819. doi: 10.1155/2015/931819. Epub 2015 Oct 12. PubMed PMID: 26543484; PubMed Central PMCID: PMC4620381.
Larsen L, Nielsen TH, Nordström CH, Andersen AB, Schierbeck J, Schulz MK, Poulsen FR. Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis. Acta Anaesthesiol Scand. 2018 Oct 17. doi: 10.1111/aas.13278. [Epub ahead of print] PubMed PMID: 30328110.
Yin L, Han Y, Miao G, Jiang L, Xie S, Liu B. CSF leukocyte, polykaryocyte, protein and glucose: Their cut-offs of judging whether post-neurosurgical bacterial meningitis has been cured. Clin Neurol Neurosurg. 2018 Sep 19;174:198-202. doi: 10.1016/j.clineuro.2018.09.023. [Epub ahead of print] PubMed PMID: 30273842.
Khan FY, Abu-Khattab M, Almaslamani EA, Hassan AA, Mohamed SF, Elbuzdi AA, Elmaki NY, Anand D, Sanjay D. Acute Bacterial Meningitis in Qatar: A Hospital-Based Study from 2009 to 2013. Biomed Res Int. 2017;2017:2975610. doi: 10.1155/2017/2975610. Epub 2017 Jul 13. PubMed PMID: 28785577; PubMed Central PMCID: PMC5530415.
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