Microbiologic features of adult community-acquired bacterial meningitis inTaiwan

Background and purpose: Community-acquired bacterial meningitis (CABM) is a life-threatening disease that requires prompt initiation of appropriate an tibiotic therapy. The purpose of this study was to determine the causative microorganisms of CABM and their antimicrobial susceptibility patterns at a major teaching hospital in Taipei from 1993 to 1998. Methods: A review of medical records and microbiologic data was used to ide ntify cases of CABM and causative pathogens, Antimicrobial susceptibility r esting fur bacterial isolates was performed by the disk diffusion method, Results: Among the 48 adult patients with a diagnosis of CABM during the st udy period, the causative pathogens were identified in 36 cases. Unlike rep orts from other countries, Klebsiella pneumoniae was the leading causative pathogen (33%), followed by Streptococcus pneumoniae (28%), Listenia monocy togenes (11%), Neisseria meningitidis (6%), Staphylococcus aureus (6%), str eptococci (6%), and Pseudomonas aeruginosa (6%). The incidence of CABM due to K, pneumoniae increased during the study period (p = 0.012, Poisson regr ession), while the incidence of CABM due to other pathogens remained stable . All of the CABM-associated K pneumoniae isolates were susceptible to cefo taxime bur 25% of the CABM-associated S. pneumoniae strains were nor suscep tible to penicillin G. Conclusions: Penicillin G alone was not an appropriate empiric therapy for adult CABM because a high percentage of cases were due to K. pneumoniae or penicillin nonsusceptible S. pneumoniae. While the recommendations for the initial empiric regimen for CABM due to S. pneumoniae in Taiwan remain to b e developed, third-generation cephalosporins appear to he an appropriate in itial empiric regimen for the treatment of CABM due to K pneumoniae.