Changing etiology of community-acquired bacterial meningitis in adults: a nationwide multicenter study in Korea

  • S.-Y. Moon
  • D. R. Chung
  • S.-W. Kim
  • H. H. Chang
  • H. Lee
  • D. S. Jung
  • Y.-S. Kim
  • S. I. Jung
  • S. Y. Ryu
  • S. T. Heo
  • C. Moon
  • H. K. Ki
  • J. S. Son
  • K. T. Kwon
  • S. Y. Shin
  • J. S. Lee
  • S. S. Lee
  • J.-Y. Rhee
  • J.-A. Lee
  • M. K. Joung
  • H. S. Cheong
  • K. R. Peck
  • J.-H. Song
Article

Abstract

Epidemiologic data on the etiologic organisms is important for appropriate empirical antibiotic treatment of bacterial meningitis. We identified the etiologies of community-acquired bacterial meningitis in Korean adults and the associated epidemiological factors. A retrospective, multicenter nationwide study was carried out. Patients 18 years of age or older with community-acquired bacterial meningitis with a confirmed pathogen were enrolled. Demographic, clinical, and microbiological data were collected. One hundred and ninety-five cases were collected. Streptococcus pneumoniae was the most common pathogen (50.8%), followed by Staphylococcus aureus (10.3%), Klebsiella pneumoniae (7.7%), Listeria monocytogenes (6.7%), and group B Streptococcus (3.1%). The penicillin resistance rate of the S. pneumoniae was 60.3%; 40.0% of the organisms were not susceptible to third-generation cephalosporins. The combination of third-generation cephalosporin with vancomycin was used in 76.3% of cases. Steroids were given before or with the first dose of antibiotics in 37.4% of patients. The 30-day mortality rate was 20.5% and neurological sequelae developed in 15.6% of cases. S. pneumoniae was the most common organism identified in community-acquired bacterial meningitis among Korean adults. S. aureus, K. pneumoniae, L. monocytogenes, and group B Streptococcus were also common. S. pneumoniae had high rates of resistance to penicillin and third-generation cephalosporins.

References

  1. 1.
    van de Beek D, de Gans J, McIntyre P, Prasad K (2004) Steroids in adults with acute bacterial meningitis: a systematic review. Lancet Infect Dis 4:139–143CrossRefPubMedGoogle Scholar
  2. 2.
    Weisfelt M, de Gans J, van der Poll T, van de Beek D (2006) Pneumococcal meningitis in adults: new approaches to management and prevention. Lancet Neurol 5:332–342CrossRefPubMedGoogle Scholar
  3. 3.
    Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39:1267–1284CrossRefPubMedGoogle Scholar
  4. 4.
    Snape MD, Pollard AJ (2005) Meningococcal polysaccharide–protein conjugate vaccines. Lancet Infect Dis 5:21–30CrossRefPubMedGoogle Scholar
  5. 5.
    Verma R, Fisher MC (2009) Bacterial meningitis vaccines: not just for kids. Curr Infect Dis Rep 11:302–308CrossRefPubMedGoogle Scholar
  6. 6.
    Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS Jr, Swartz MN (1993) Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 328:21–28CrossRefPubMedGoogle Scholar
  7. 7.
    Sigurdardóttir B, Björnsson OM, Jónsdóttir KE, Erlendsdóttir H, Gudmundsson S (1997) Acute bacterial meningitis in adults. A 20-year overview. Arch Intern Med 157:425–430CrossRefPubMedGoogle Scholar
  8. 8.
    Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH (2009) Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 360:244–256CrossRefPubMedGoogle Scholar
  9. 9.
    Tsai CJ, Griffin MR, Nuorti JP, Grijalva CG (2008) Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States. Clin Infect Dis 46:1664–1672CrossRefPubMedGoogle Scholar
  10. 10.
    Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, Facklam RR, Jorgensen JH, Schuchat A (2003) Decline in invasive pneumococcal disease after the introduction of protein–polysaccharide conjugate vaccine. N Engl J Med 348:1737–1746CrossRefPubMedGoogle Scholar
  11. 11.
    Chang WN, Lu CH, Huang CR, Tsai NW, Chuang YC, Chang CC, Chen SF, Chien CC (2008) Changing epidemiology of adult bacterial meningitis in southern Taiwan: a hospital-based study. Infection 36:15–22CrossRefPubMedGoogle Scholar
  12. 12.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140CrossRefPubMedGoogle Scholar
  13. 13.
    Clinical and Laboratory Standards Institute (CLSI) (2008) Performance standards for antimicrobial susceptibility testing: 18th informational supplement. Document M100-S18. CLSI, Wayne, PAGoogle Scholar
  14. 14.
    National Institute of Alcohol Abuse and Alcoholism (NIAAA) (2004) NIAAA council approves definition of binge drinking. NIAAA Newsletter 3:3Google Scholar
  15. 15.
    Stahre M, Naimi T, Brewer R, Holt J (2006) Measuring average alcohol consumption: the impact of including binge drinks in quantity–frequency calculations. Addiction 101:1711–1718CrossRefPubMedGoogle Scholar
  16. 16.
    van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859CrossRefPubMedGoogle Scholar
  17. 17.
    Hussein AS, Shafran SD (2000) Acute bacterial meningitis in adults. A 12-year review. Medicine (Baltimore) 79:360–368CrossRefGoogle Scholar
  18. 18.
    Lazzarini L, Toti M, Fabris P, Conti E, Magni G, Mazzotta F, De Lalla F (2008) Clinical features of bacterial meningitis in Italy: a multicenter prospective observational study. J Chemother 20:478–487PubMedGoogle Scholar
  19. 19.
    Meyer CN, Samuelsson IS, Galle M, Bangsborg JM (2004) Adult bacterial meningitis: aetiology, penicillin susceptibility, risk factors, prognostic factors and guidelines for empirical antibiotic treatment. Clin Microbiol Infect 10:709–717CrossRefPubMedGoogle Scholar
  20. 20.
    Brouwer MC, Keizerweerd GD, De Gans J, Spanjaard L, Van De Beek D (2009) Community acquired Staphylococcus aureus meningitis in adults. Scand J Infect Dis 41:375–377CrossRefPubMedGoogle Scholar
  21. 21.
    Kim ES, Song JS, Lee HJ, Choe PG, Park KH, Cho JH, Park WB, Kim SH, Bang JH, Kim DM, Park KU, Shin S, Lee MS, Choi HJ, Kim NJ, Kim EC, Oh MD, Kim HB, Choe KW (2007) A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea. J Antimicrob Chemother 60:1108–1114CrossRefPubMedGoogle Scholar
  22. 22.
    Ko WC, Paterson DL, Sagnimeni AJ, Hansen DS, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, Mulazimoglu L, Trenholme G, Klugman KP, McCormack JG, Yu VL (2002) Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis 8:160–166CrossRefPubMedGoogle Scholar
  23. 23.
    Lu CH, Chang WN, Chang HW (2000) Adult bacterial meningitis in Southern Taiwan: epidemiologic trend and prognostic factors. J Neurol Sci 182:36–44CrossRefPubMedGoogle Scholar
  24. 24.
    Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, Kim JS, Choi YH, Lee JS, Chung MH, Kim YS, Lee H, Lee MS, Park CK (2007) Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect 54:578–583CrossRefPubMedGoogle Scholar
  25. 25.
    Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT (2004) A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 199:697–705CrossRefPubMedGoogle Scholar
  26. 26.
    Kim JK, Chung DR, Wie SH, Yoo JH, Park SW (2009) Risk factor analysis of invasive liver abscess caused by the K1 serotype Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 28:109–111CrossRefPubMedGoogle Scholar
  27. 27.
    Ayvazian LF (1948) Friedländer bacillus meningitis successfully treated with streptomycin; consideration of Friedländer bacillus infections in diabetes. Am J Med 5:470–477CrossRefPubMedGoogle Scholar
  28. 28.
    Schuchat A, Swaminathan B, Broome CV (1991) Epidemiology of human listeriosis. Clin Microbiol Rev 4:169–183PubMedGoogle Scholar
  29. 29.
    van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354:44–53CrossRefPubMedGoogle Scholar
  30. 30.
    Farley MM, Harvey RC, Stull T, Smith JD, Schuchat A, Wenger JD, Stephens DS (1993) A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med 328:1807–1811CrossRefPubMedGoogle Scholar
  31. 31.
    Pfister HW, Feiden W, Einhäupl KM (1993) Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 50:575–581PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • S.-Y. Moon
    • 1
  • D. R. Chung
    • 1
  • S.-W. Kim
    • 2
  • H. H. Chang
    • 2
  • H. Lee
    • 3
  • D. S. Jung
    • 3
  • Y.-S. Kim
    • 4
  • S. I. Jung
    • 5
  • S. Y. Ryu
    • 6
  • S. T. Heo
    • 7
  • C. Moon
    • 8
  • H. K. Ki
    • 9
  • J. S. Son
    • 10
  • K. T. Kwon
    • 11
  • S. Y. Shin
    • 12
  • J. S. Lee
    • 13
  • S. S. Lee
    • 14
  • J.-Y. Rhee
    • 15
  • J.-A. Lee
    • 1
  • M. K. Joung
    • 1
  • H. S. Cheong
    • 1
  • K. R. Peck
    • 1
  • J.-H. Song
    • 1
  1. 1.Division of Infectious Diseases, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Kyungpook National University HospitalDaeguSouth Korea
  3. 3.Dong-A University HospitalBusanSouth Korea
  4. 4.Chungnam National University HospitalDaejonSouth Korea
  5. 5.Chonnam National University HospitalGwangjuSouth Korea
  6. 6.Keimyung University Dongsan Medical CenterDaeguSouth Korea
  7. 7.Gyeongsang National University HospitalJinjuSouth Korea
  8. 8.Inje University Busan Paik HospitalBusanSouth Korea
  9. 9.Konkuk University HospitalSeoulSouth Korea
  10. 10.Kyung Hee University East-West Neo Medical CenterSeoulSouth Korea
  11. 11.Daegu Fatima HospitalDaeguSouth Korea
  12. 12.Cheju National University HospitalJejuSouth Korea
  13. 13.Kangdong Sacred Heart HospitalSeoulSouth Korea
  14. 14.Hallym University Sacred Heart HospitalGyeonggi-doSouth Korea
  15. 15.Dankook University HospitalCheonanSouth Korea

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