Anaerobic bacterial meningitis in adults. (April 2018)

• Record Type: Journal Article
• Authors: Lee, Jun-Jun; Lien, Chia-Yi; Chien, Chun-Chih; Huang, Chi-Ren; Tsai, Nai-Wen; Chang, Chiung-Chih; Lu, Cheng-Hsien; Chang, Wen-Neng
• Is Part Of: Journal of clinical neuroscience. Volume 50(2018)
• Page Start: 45
• Page End: 50
• Publication Date: 2018-04
• Subjects: Anaerobic -- Adult bacterial meningitis -- Postneurosurgical state -- Mixed infection; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.01.014
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Anaerobic infection in adult bacterial meningitis (ABM) is rarely reported. The clinical characteristics of 13 ABM patients were analyzed. Anaerobic infections accounted for at least 2.4% (13/540) of the overall ABM. The incidences of postneurosurgical infections and mixed infections were high. The mortality rate was 30.8% (4/13) and seizure was the significant prognostic factor. Abstract: Anaerobic infection is a very uncommon condition in adult bacterial meningitis (ABM), and its clinical characteristics have yet to be clarified. We enrolled 540 patients with culture-proven bacterial meningitis during a study period of 30 years (1986–2015), of whom 13 (2.4%) had anaerobic infections. These 13 patients were eight men and five women, aged 22–77 years. Among them, 53.8% (7/13) had a postneurosurgical state as the preceding event, and 79.6% (10/13) had underlying medical conditions including diabetes mellitus, malignancy, liver cirrhosis, cerebral infarct and alcoholism. Nosocomial and mixed infections were found in 15.5% (2/13) and 46.1% (6/13) of the patients, respectively. A total of 14 anaerobic strains were isolated from cerebrospinal fluid specimens, including nine Gram-negative (G(−)) strains: Fusobacterium nucleatum (3), Prevotella species (3) and Bacteroides fragilis (3), and five Gram-positive (G(+)) strains: Propionibacterium acnes (3) and Peptostreptococcus micros (also known as Parvimonas micra ) (2). All of the implicated G(+) anaerobic bacteria were susceptible to penicillin, and no multiple drug-resistant strains were found among the implicated G(−) anaerobic bacteria. Despite treatment, 30.8% (4/13) of the patients died. Of the nine survivors, 22.2% (2/9) had a full recovery, while the other 77.8% (7/9) had varying degrees of neurological deficits. Compared with the good outcome group (n = 6, modified Rankin scale (mRS) scores: 0–2), the poor outcome group (n = 7, mRS scores ≧3) had higher incidence of seizure. These results may offer a preliminary view of the clinical characteristics of anaerobic ABM.