One-year prospective study of meningitis diagnosed at a third level hospital

Objective. One-year prospective observational study of meningitis diagnosed at a third level hospital. Patients and methods. All patients with a cerebrospinal fluid (CSF) specime n with cyto-biochemical characteristics and clinical picture consistent wit h meningitis were included in the study, They were followed from admission to hospital up to discharge or exitus. The epidemiologic characteristics of patients, etiology, related risk factors and predisposing situations, CSF characteristics, clinical manifestations, clinical course; and antibiotic s usceptibility of the causative agents were analyzed. Results. Ninety-five cases were included. Seventy-six (69.4%) were communit y acquired and 29 (30.5%) nosocomially acquired meningitis. Among community acquired meningitis, 31 (46.9%) were of bacterial origin (8 N. meningitidi s, 3 H. influenzae, 2 S. pneumoniae, 1 Streptococcus group B, 1 Listeria mo nocytogenes, 1 Staphylococcus aureus, and 1 Brucella spp.); CSF culture was negative in 14 cases (41.2%). in most cases neither risk factor nor predis posing situations were detected. Patients with purulent meningitis and nega tive CSF culture had a significantly lower number of complications than pat ients with positive CSF culture. Among patients previously treated with bet a-lactam antibiotics (8 cases), the probability of a negative CSF culture w as greater than among not treated patients (OR 16.00, 95% CI 1.45-764.68; p = 0.011). The remaining cyto-biochemical characteristics were similar in b oth groups. Thirty-five cases (53.03%) of community acquisition were lympho cytic meningitis (31 viral, 3 tuberculous, and 1 luetic meningitis). Among nosocomial cases (29 cases, 30.5%), most were caused by gram-negative bacil li and microorganisms of the Staphylococcus genus. Fourteen cases (48.2%) w ere related to some type of neurosurgical procedure. Overall, only two exit us eases were recorded. Conclusions. The etiologic agents of community acquired meningitis are main ly N. meningitidis, S. pneumoniae and Haemophilus influenzae. The previous antibiotic therapy did not influence thy cyto-biochemical characteristics o f CSF but it did influence the yielding of culture. Meningitis with negativ e CSF culture has a significantly lower number of complications. The availa bility of a Neurosurgery Department at a hospital confers a change in the e pidemiologic spectrum of diagnosed meningitis, with a higher incidence of n osocomial meningitis. In our environment, a substantial proportion of cases due to Staphylococcus microorganisms was observed.