Jointfluid aspirations were performed in 23 of 48 patients 48% and jointfluid cultures yielded bacteria in 6 of 23 patients 26%. First, the introduction of conjugate vaccines in europe resulted in the virtual disappearance of. The pathogenesis of bacterial meningitis is based on complex and incompletely understood hostpathogen interactions. Two hundred and eighty six patients with communityacquired bacterial meningitis aged 14 years and more were included in this retrospective cohort study. At that time, it can be downloaded free in pdf format from. Communityacquired acute bacterial meningitis in adults. Case series from a prospective nationwide cohort study from dutch hospitals from 2006 to 2009.
Presented at the 43rd annual meeting of the infectious diseases society of america, san francisco, ca. Hydrocephalus in adults with communityacquired bacterial. Jul 15, 20 community acquired bacterial meningitis cabm continues to have a high mortality rate and often results in severe sequelae among survivors. Risk factors and prognosis of seizures in adults with. Bacterial meningitis in older adults is a wellstudied and serious disease, but few studies have investigated the epidemiology and outcomes of communityacquired meningitis in older adults. Two hundred and eighty six patients with community acquired bacterial meningitis aged 14 years and more were included in this retrospective cohort study. Bacterial meningitis in patients with csf leakage can be classified as community acquired, in case of anatomic defects or contiguous spread of infection, or nosocomial or healthcareassociated meningitis after surgery for trauma 5, 7,8. Attributes of good guidelines include validity, reliability, reproducibility, clinical applicability, clinical flexibility, clarity, multidisciplinary process. It explains the initial assessment and management, the use of adjunctive corticosteroi. To identify factors associated with unfavourable inhospital outcome death or disability in adults with communityacquired bacterial meningitis cabm.
Inclusion and exclusion criteria are described more extensively elsewhere. Hospitalacquired meningitis is rapidly increasing and adding an immense burden to the health system due to the emergence of multidrug resistance isolates. Causative bacteria in communityacquired bacterial meningitis vary depending on age. To analyze deaths of adults hospitalized for communityacquired bacterial meningitis more accurately, strict definitions of meningitisrelated causes of death were created in accordance with the criteria of the world health organization and national center for health statistics 20, 21. Acute communityacquired bacterial meningitis in adults. To aid in this field of research we set out to ascertain the risk and outcome of. Communityacquired group b streptococcal meningitis in adults.
Pdf acute communityacquired bacterial meningitis in adults. Pathophysiology and treatment of bacterial meningitis ncbi. The existing heterogeneity in diagnostic workup and treatment strategies in bacterial meningitis was the incentive to develop. Pdf communityacquired bacterial meningitis in adults.
In summary, all patients were aged 16 years and had cerebrospinal fluid csf culture proven bacterial. All adults patients admitted to the participating hospitals with the diagnosis of acute community acquired bacterial meningitis acabm were included in this study. To create and test a prognostic model for persons with communityacquired bacterial meningitis and to determine whether antibiotic timing influences clinical outcome. Bacterial meningitis, acute communityacquired johns. Communityacquired bacterial meningitis in adults with cancer.
Methods we conducted a retrospective study of 619 adults in houston, texas, with community acquired meningitis hospitalized between january 1, 2005, and. In adults presenting with communityacquired acute bacterial meningitis, the sen. The escmid guideline advises to start empiric treatment within one hour of arrival in all suspected meningitis cases, and choice of antibiotics needs to be. Dilemmas in the diagnosis of acute communityacquired. Design observational cohort studies setting denmark participants in the derivation cohort, we retrospectively included all adults 15 years of age with cabm in north denmark region from 1998 to 2014 and at hvidovre and hillerod hospitals from 2003 to 2014. Observational period was between 1 january 1990 and 31 december 2004. Communityacquired bacterial meningitis in adults article pdf available in new england journal of medicine 3541.
Objective to examine predefined risk factors and outcome of seizures in communityacquired bacterial meningitis cabm. Dilemmas in the diagnosis of acute communityacquired bacterial. To study the incidence, clinical presentation, causative bacteria, and outcome of communityacquired bacterial meningitis in adults with cancer. Sep 24, 2018 community acquired spontaneously occurring e. Only colistin and imipenem were effective antibiotics against them.
Threeyear multicenter surveillance of communityacquired. Older people more often presented with the triad of fever, neck stiffness, and altered mental status than younger adults 58% vs 36%. Acute communityacquired bacterial meningitis is a medical emergency, and patients with this disease need immediate medical assessment and treatment. Bacterial meningitis is a lifethreatening disease that is associated with considerable mortality and morbidity. Bacterial meningitis is a serious inflammation of the meninges caused by various bacteria. To study the incidence, clinical presentation, causative bacteria, and outcome of community acquired bacterial meningitis in adults with cancer. Community acquired bacterial meningitis in adults in the netherlands, 200614. It is widely acknowledged that prompt recognition, appropriate investigation and treatment save lives. Some of these are pathogenspecific, while some are shared between. Acute communityacquired bacterial meningitis in adults admitted to the intensive care unit. Recurrent bacterial meningitis has been estimated to occur in 4%9% of all patients with communityacquired bacterial meningitis. Communityacquired bacterial meningitis in adults with. Communityacquired bacterial meningitis in elderly patients. Hydrocephalus is a rare outcome in communityacquired.
Hydrocephalus was diagnosed in 26 of 577 episodes 5% and was classified as communicating hydrocephalus in all but 1 patient. Communityacquired bacterial meningitis is a serious and lifethreatening disease. To improve this knowledge, all episodes of communityacquired bacterial meningitis were prospectively recorded and cases occurring in patients. Pdf the aetiology of acute community acquired bacterial. Communityacquired bacterial meningitis cabm continues to have a high mortality rate and often results in severe sequelae among survivors. Arthritis in adults with communityacquired bacterial. Clinical features alone cannot determine whether meningitis. Bacterial meningitis is very serious and can be deadly. Acute bacterial meningitis continues to be a potentially life threatening condition. Community acquired bacterial meningitis causes substantial morbidity and mortality in adults.
Update on communityacquired bacterial meningitis sciencedirect. Lately, an increased effort has been focused on describing the neurological complications of meningitis including hydrocephalus. In this cohort study, we prospectively assessed adults age 16 years with community acquired bacterial meningitis in the netherlands, identified through the national reference laboratory for bacterial meningitis or individual physicians between jan 1, 2006, and july 1, 2014. Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. Bacterial communityacquired determinants longterm outcome prognosis abstract objectives. To evaluate the occurrence, treatment, and outcome of hydrocephalus complicating communityacquired bacterial meningitis in adults.
Causative bacteria in community acquired bacterial meningitis vary depending on age. The aetiology of acute community acquired bacterial meningitis in children and adults in maputo, mozambique. Recent findings indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Emerging multidrug resistance isolates of hospital. Communityacquired recurrent bacterial meningitis in adults. During the period 19772006, 675 episodes in adults aged. Communityacquired bacterial meningitis in adults practical. Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances. Acute bacterial meningitis abm is a medical emergency associated with considerable morbidity and mortality. Update and advances in community acquired bacterial meningitis. Community acquired bacterial meningitis inflammation of the meninges is most commonly caused by streptococcus pneumoniae or neisseria meningitidis. However, permanent disabilities such as brain damage, hearing loss, and learning disabilities can result from the infection. Oct 01, 2001 to analyze deaths of adults hospitalized for community acquired bacterial meningitis more accurately, strict definitions of meningitis related causes of death were created in accordance with the criteria of the world health organization and national center for health statistics 20, 21. Communityacquired bacterial meningitis i n adults in the netherlands, 200614.
All adults patients admitted to the participating hospitals with the diagnosis of acute communityacquired bacterial meningitis acabm were included in this study. Bacterial meningitis is a potentially catastrophic infectious disease associated with substantial mortality and a risk of permanent disability in survivors. The purpose of this study is to find the antibiotic susceptibility pattern of the bacteria detected from hospital and community. For 74 patients with community acquired bacterial meningitis who died during hospitalization, the underlying and. The dutch meningitis cohort study, a prospective nationwide observational cohort study in the netherlands, includes 696 episodes of communityacquired acute bacterial meningitis. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid csf culture or blood culture. Streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae type b hib are the predominant causative pathogens in both adults and children. Communityacquired bacterial meningitis causes substantial morbidity and mortality in adults. In adults and children after the neonatal period the most common pathogens are streptococcus pneumoniae and neisseria meningitis, while in neonates streptococcus agalactiae group b streptococci. The diagnosis of arthritis was based upon the judgment of the treating physician. P initial management, and prevention of meningitis.
Hydrocephalus was diagnosed in 26 of 577 episodes 5% and was classified as. To create and test a prognostic model for persons with community acquired bacterial meningitis and to determine whether antibiotic timing influences clinical outcome. Risk factors for communityacquired bacterial meningitis. Various risk factors have been identified for the same. To identify differences between groups fisher exact statistics and the mannwhitney u test were used. To aid in this field of research we set out to ascertain the risk and outcome of hydrocephalus in patients with community. Lifethreatening inflammation of the meninges caused by various bacteria. Bacterial meningitis is a medical, neurologic, and sometimes. Communityacquired bacterial meningitis cabm is a lifethreatening infection that can be complicated by neurological deficits among. Arthritis was recorded in 48 of 696 7% episodes of community acquired bacterial meningitis in adults.
These outcomes have prompted interventions in prevention and treatment. Acute community acquired bacterial meningitis flashcards. Emerging multidrug resistance isolates of hospitalacquired. The incidence of communityacquired bacterial meningitis was highest in 200708, with 172 cases per 100 000 adults per year, and subsequently declined to 094 per 100 000 adults per year in 2014. The incidence of communityacquired bacterial meningitis in the general population is estimated around 5100 000 000 000 adults per year. A case was defined as an adult patient age 16 yrs with communityacquired symptoms of meningitis fever, headache, stiff neck, altered mental status or focal neurological symptoms and cerebrospinal fluid csf white cell count 5 cellsmm 3, who presented to an emergency department ed between january 1. Although the pathogenesis of bacterial meningitis is not completely understood, knowledge of bacterial invasion and entry into the cns is improving. Pdf acute communityacquired bacterial meningitis in. Methods we conducted a retrospective study of 619 adults in houston, texas, with communityacquired meningitis hospitalized between january 1, 2005, and. Meningitis about bacterial meningitis infection cdc. Epidemiology of invasive meningococcal disease in the netherlands, 19602012.
Communityacquired bacterial meningitis in adults nejm. In the past decades the epidemiology and treatment strategies for communityacquired bacterial meningitis have significantly changed. Communityacquired bacterial meningitis in adults in the netherlands, 200614. We evaluated incidence and characteristics of patients with cancer included in a nationwide prospective cohort study of adults with communityacquired meningitis performed in the. Endocarditis in adults with bacterial meningitis circulation. In adults with communityacquired bacterial meningitis, 25 percent have recent otitis. Abstract bacterial meningitis is a medical emergency. We evaluated incidence and characteristics of patients with cancer included in a nationwide prospective cohort study of adults with community acquired meningitis performed in the netherlands from march 1, 2006, to september 31, 2014. A prospective cohort study article pdf available in the lancet infectious diseases 163 december 2015 with 539. It explains the initial assessment and management, the. Community acquired bacterial meningitis in adults request pdf.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Di lemmas exist in the diagnosis of patients with bacterial meningitis, because clinical. The absence of neck rigidity, kernigs sign and brudzinskis sign does not rule out acute bacterial meningitis. Over the past several decades, the incidence of bacterial meningitis in children has decreased but there remains a significant burden of disease in adults, with a mortality of up to 30%. Communityacquired escherichia coli meningitis with. Bacterial meningitis in older adults is a wellstudied and serious disease, but few studies have investigated the epidemiology and outcomes of community acquired meningitis in older adults. Among them, alcoholism with cirrhosis, uncontrolled diabetes. Likewise gram positive organisms were susceptible to most of the antibiotics tested. Bacterial meningitis is a severe infection with substantial mortality and morbidity 1, 2. The most common causes of communityacquired bacterial meningitis in adults are streptococcus pneumoniae and neisseria meningitidis. Bacterial meningitis, acute communityacquired is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Symptoms suggestive of csf leakage include rhinorrhea and otorrhea, but csf leakage may also go unnoticed 9. Bacterial meningitis symptoms, diagnosis and treatment. All the gram negative isolates were multidrug resistance.
Communityacquired bacterial meningitis in adults in the. Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. Communityacquired bacterial meningitis cabm is a lifethreatening infection that can be complicated by neurological deficits among survivors. To evaluate the occurrence, treatment, and outcome of hydrocephalus complicating community acquired bacterial meningitis in adults. Start studying acute community acquired bacterial meningitis.