THE PROGNOSTIC FACTORS OF ADULT GRAM-NEGATIVE BACILLARY MENINGITIS

Seventy-seven patients with Gram-negative bacillary meningitis (GNBM), 57 males and 20 females, aged 17-86 years, were identified at Kaohsiu ng Chang Gung Memorial Hospital, over an Ii-year period. Fifty-four in fections were community-acquired, and 23 were nosocomial; 49 were spon taneous and 28 occurred after head surgery or neurosurgery. The organi sms most frequently involved were Klebsiella pneumoniae, Pseudomonas a eruginosa, Escherichia coli, and Acinetobacter. Rarer pathogens includ ed Citrobacter species, Serratia marcescens, Enterobacter cloacae, and Proteus mirabilis. All patients who did not receive appropriate antib iotic therapy died. The mortality in those treated with appropriate an tibiotics was 28%. Other statistically significant prognostic factors included septic shock, initial level of consciousness: hyperosmolar hy perglycemic nonketotic coma, disseminated intravascular coagulation, h igh cerebrospinal fluid lactate levels and leucocytosis. In the multip le logistic regression analysis, only appropriate antimicrobial therap y and septic shock were strongly associated with mortality even after adjusting for other potentially confounding factors. Despite the high mortality, management can be improved by early diagnosis, early use of appropriate antibiotics, and correction of underlying and associated medical derangement.