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August 23, 1993

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

Author Affiliations

From the Department of Clinical Microbiology, Bispebjerg Hospital (Drs Jensen and Frimodt-Møller), the Departments of Clinical Microbiology (Dr Espersen) and Infectious Diseases (Dr Skinhøj), Rigshospitalet, and the Staphylococcus Laboratory, Statens Seruminstitut (Dr Rosdahl), Copenhagen, Denmark.

Arch Intern Med. 1993;153(16):1902-1908. doi:10.1001/archinte.1993.00410160066005

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)