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Bacterial Meningitis in Older Adults

  • NEUROLOGIC MANIFESTATIONS OF SYSTEMIC DISEASE (A PRUITT, SECTION EDITOR)
  • Published:
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Opinion statement

The burden of disease due to bacterial meningitis is shifting toward older adults. Clinicians should maintain a high level of suspicion of meningitis in older adults, since they may present without classic signs and symptoms. Clinicians should remember that more older patients are at risk of healthcare-associated meningitis and may be at risk of more resistant organisms. A lumbar puncture should be performed as quickly as possible. If a CT scan is required before the lumbar puncture, blood cultures should be drawn and appropriate empiric antibiotics should be started before sending the patient to the CT scanner. Empiric antibiotics should be chosen based on patient history, review of patient's known illnesses and risk factors, results of CSF Gram stain, and local institution antibiotic resistance patterns. Clinicians should remember that Streptococcus pneumoniae may be resistant to penicillin and cephalosporins, so vancomycin is usually also administered until the bacterial resistance pattern is known. Adjunctive dexamethasone may be started before or at the time of antibiotic therapy based on risk versus benefit analysis, and may be discontinued if patient is found to not have Streptococcus pneumoniae meningitis.

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References and Recommended Reading

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. McIntyre PB, O’Brien KL, Greenwood B, van de Beek D. Effect of vaccines on bacterial meningitis worldwide. Lancet. 2012;380:1703–11. This is a review summarizing the effect of vaccines on meningitis worldwide.

    Article  PubMed  Google Scholar 

  2. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364:2016–25.

    Article  PubMed  CAS  Google Scholar 

  3. Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995, Active surveillance team. N Engl J Med. 1997;337:970–6.

    Article  PubMed  CAS  Google Scholar 

  4. Rasmussen HH, Sorensen HT, Moller-Peterson J, et al. Bacterial meningitis in elderly patients: Clinical picture and course. Age and Ageing. 1992;21:216–20.

    Article  PubMed  CAS  Google Scholar 

  5. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med. 1993;328:21–8.

    Article  PubMed  CAS  Google Scholar 

  6. Begg N, Cartwright KAV, Cohen J, et al. Consensus statement on diagnosis, investigation, treatment, and prevention of acute bacterial meningitis in immunocompetent adults. J Infect. 1999;39:1–15.

    Article  PubMed  CAS  Google Scholar 

  7. Cabellos C, Verdaguer R, Olmo M, et al. Community-acquired bacterial meningitis in elderly patients. Experience over 30 years. Medicine. 2009;88:115–9.

    Article  PubMed  Google Scholar 

  8. Khassawneh FA, Smalligan RD, Mohamad TN, et al. Lumbar puncture for suspected meningitis after intensive care unit admission is likely to change management. Hosp Pract. 2011;39:141–5.

    Article  Google Scholar 

  9. Jackson WL, Shorr AF. The yield of lumbar puncture to exclude nosocomial meningitis as aetiology for mental status changes in the medical intensive care unit. Anaesth Intensive Care. 2006;34:21–4.

    PubMed  Google Scholar 

  10. Laxmi S, Tunkel A. Healthcare-associated bacterial meningitis. Curr Infect Dis Rep. 2011;13:367–73. This is a review article discussing the new term healthcare-associated meningitis.

    Article  PubMed  Google Scholar 

  11. Lai W, Chen S, Tsai N, et al. Clinical characteristics and prognosis of acute bacterial meningitis in elderly patients over 65: a hospital-based study. BMC Geriatr. 2011;11:91–6. This is a retrospective review of bacterial meningitis in elderly patients.

    Article  PubMed  Google Scholar 

  12. Chang WN, Huang CR, Lu CH, Chien CC. Adult Klebsiella pneumoniae meningitis in Taiwan: An overview. Acta Neurol Taiwan. 2012;21:87–96.

    PubMed  Google Scholar 

  13. van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med. 2010;362:146–54. This review article discusses in depth nosocomonial bacterial meningitis, organisms involved and treatments.

    Article  PubMed  Google Scholar 

  14. Conen A, Walti LN, Merlo A, et al. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008;47:73–82.

    Article  PubMed  Google Scholar 

  15. Lu CH, Chang WN, Chuang YC, Chang HW. Gram-negative bacillary meningitis in adult post-neurosurgical patients. Surg Neurol. 1999;52:438–43.

    Article  PubMed  CAS  Google Scholar 

  16. McClelland S, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45:55–9.

    Article  PubMed  Google Scholar 

  17. Domingo P, Pomar V, DeBenito N, et al. The spectrum of acute bacterial meningitis in elderly patients. BMC Infect Dis. 2013;13:108–17.

    Article  PubMed  Google Scholar 

  18. van Crevel H, Hijdra A, de Gans J. Lumbar puncture and the risk of herniation: when should we first perform CT? J Neurol. 2002;249:129–37.

    Article  PubMed  Google Scholar 

  19. Feigin RD, Stechenberg BW, Chang MJ, et al. Prospective evaluation of treatment of Haemophilus influenzae meningitis. J Pediatr. 1976;88:542–8.

    Article  PubMed  CAS  Google Scholar 

  20. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84.

    Article  PubMed  Google Scholar 

  21. Hasbun R, Abrahams J, Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001;345:1727–33.

    Article  PubMed  CAS  Google Scholar 

  22. Auburtin M, Wolf M, Charpentier J, et al. Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med. 2006;34:2758–65.

    Article  PubMed  CAS  Google Scholar 

  23. Greig PR, Goroszeniuk D. Role of computed tomography before lumbar puncture: a survey of clinical practice. Postgrad med J. 2006;82:162–5.

    Article  PubMed  CAS  Google Scholar 

  24. Brouwer MC, Thwaites GE, Turkel AR, van de Beak D. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet. 2012;380:1684–92. This review article discusses diagnostic dilemmas that are common with bacterial meningitis.

    Article  PubMed  Google Scholar 

  25. Talan DA, Guterman JJ, Overturf GD, et al. Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med. 1989;18:856–62.

    Article  PubMed  CAS  Google Scholar 

  26. Proulx N, Fre’chette D, Toye B, Chan J, Kravcik S. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM Int J med. 2005;98:291–8.

    Article  CAS  Google Scholar 

  27. Schut ES, de Gans J, van de Beak D. Community-acquired bacterial meningitis in adults. Pract Neurol. 2008;8:8–23.

    Article  PubMed  Google Scholar 

  28. de Gans J, Van de Beak D. European Dexamethasone in adulthood bacterial meningitis study investigators.: Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.

    Article  PubMed  Google Scholar 

  29. Centers for Disease Control and Prevention. Effects of new penicillin susceptibility breakpoints for Streptococcus pneumoniae—United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2008;57:1353–5.

    Google Scholar 

  30. van de Beek D, Brouwer MC, Thwaites GE, et al. Advances in treatment of bacterial meningitis. Lancet. 2012;380:1693–702. This review article discusses basic principles and treatment of bacterial meningitis.

    Article  PubMed  Google Scholar 

  31. Bartlett JG, Pham PA. John Hopkins Abx guide. Diagnosis and treatment of infectious disease. In: Bartlett JG, Auwaeter PG, Pham PA, editors. Antibiotics. Massachusetts: Jones and Bartlett Learning; 2012. p. 473–661.

    Google Scholar 

  32. Chang C, Mahmood MM, Teuber SS, et al. Overview of penicillin allergy. Clin Rev Allergy Immunol. 2012;43:84–97.

    Article  PubMed  CAS  Google Scholar 

  33. Frank M. Systemic and CNS toxicities of antimicrobial agents. Central nervous System Infectious Diseases and Therapy. Edited by Roos KL. New York: Marcel Dekker; 1987:711–730.

  34. Nau R, Sörgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood–brain barrier for treatment of central nervous system infections. Clin Microbiol Rev. 2010;23:858–83.

    Article  PubMed  CAS  Google Scholar 

  35. Ricard JD, Wolff M, Lacherade JC, et al. Levels of vancomycin in cerebrospinal fluid of adult patients receiving adjunctive corticosteroids to treat pneumococcal meningitis: a prospective multicenter observational study. Clin Infect Dis. 2007;44:250–5.

    Article  PubMed  CAS  Google Scholar 

  36. Klugman KP, Dagan R. Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis: Meropenem Meningitis Study Group. Antimicrob Agents Chemother. 1995;39:1140–6.

    Article  PubMed  CAS  Google Scholar 

  37. Latorre C, Gené A, Juncosa T, Muñoz C, González-Cuevas A. Neisseria meningitidis: evolution of penicillin resistance and phenotype in a children’s hospital in Barcelona, Spain. Acta Paediatr. 2000;89:661–5.

    Article  PubMed  CAS  Google Scholar 

  38. Richter SS, Gordon KA, Rhomberg PR, et al. Neisseria meningitidis with decreased susceptibility to penicillin: Report from Sentry antimicrobial surveillance program, North America, 1998–1999. Diag Microb Infect Dis. 2001;41:83–8.

    Article  CAS  Google Scholar 

  39. Wu HM, Harcourt BH, Hatcher CP, et al. Emergence of ciprofloxacin-resistant Neisseria meningitidis in North America. N Engl J Med. 2009;360:886–92.

    Article  PubMed  CAS  Google Scholar 

  40. Lapadula G, Viganò F, Fortuna P, et al. Imported ciprofloxacin-resistant Neisseria meningitidis. Emerg Infect Dis. 2009;15:1852–4.

    Article  PubMed  Google Scholar 

  41. Cottagnoud P, Täuber M. Fluoroquinolones in the Treatment of Meningitis. Curr Infect Dis Rep. 2003;5:329–36.

    Article  PubMed  Google Scholar 

  42. Darabi A, Hocquet D, Dowzicky MJ. Antimicrobial activity against Streptococcus pneumoniae and Haemophilus influenzae collected globally between 2004 and 2008 as part of the Tigecycline Evaluation and Surveillance Trial. Diagn Microbiol Infect Dis. 2010;67:78–86.

    Article  PubMed  CAS  Google Scholar 

  43. Sum L, Gomolin I. Cefepime neurotoxicity: Case report, pharmacokinetic considerations and literature review. Pharmacotherpy. 2006;26:1169–74.

    Article  Google Scholar 

  44. Chow KM, Szeto CC, Hui AC. Retrospective review of neurotoxicity induced by cefepime and cetazidime. Pharmacotherapy. 2003;23:369–73.

    Article  PubMed  CAS  Google Scholar 

  45. Amaya-Villar R, García-Cabrera E, Sulleiro-Igual E, et al. Three-year multicenter surveillance of community acquired Listeria monocytogenes meningitis in adults. BMC Infect Dis. 2010;10:324–32.

    Article  PubMed  Google Scholar 

  46. Moragas M, Martínez-Yélamos S, Majós C, et al. Rhombencephalitis: a series of 97 patients. Medicine. 2011;90:256–61.

    Article  PubMed  Google Scholar 

  47. Lu CH, Chang WN, Chuang YC, Chang HW. The prognostic factors of adult Gram-negative bacillary meningitis. J Hosp Infect. 1998;40:27–34.

    Article  PubMed  CAS  Google Scholar 

  48. Kim HI, Kim SW, Park GY, et al. The causes and treatment outcomes of 91 patients with adult nosocomial meningitis. Korean J Intern Med. 2012;27:171–9.

    Article  PubMed  CAS  Google Scholar 

  49. Garnach-Montero J, Amaya-Willar R. Multiresistant Acinetobacter baumannii infections: epidemiology and management. Curr Opin Infect Dis. 2010;23:332–9.

    Article  Google Scholar 

  50. Falagas ME, Bliziotio IA, Tam VH. Intraventricular or intrathecal use of polymyxins in patients with Gram-negative meningitis: a systematic review of the available evidence. Int J Antimicrob Agents. 2007;29:9–25.

    Article  PubMed  CAS  Google Scholar 

  51. Katragdou A, Roilides E. Successful treatment of multidrug resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbial. 2005;43:4916–7.

    Article  Google Scholar 

  52. Huang CR, Lu CH, Chuang YC, et al. Adult Pseudomonas aeruginosa meningitis: high incidence of underlying medical and/or post neurosurgical conditions and high mortality rate. Jpn J Infect Dis. 2007;60:397–9.

    PubMed  CAS  Google Scholar 

  53. Markantonis SL, Markou N, Fousteri M, et al. Penetration of colistin into cerebrospinal fluid. Antimicrob Agents Chemother. 2009;53:4907–10.

    Article  PubMed  CAS  Google Scholar 

  54. Segal-Maurer S, Mariano N, Qavi A, et al. Successful treatment of ceftaxidime-resistant Klebsiella pneumoniae ventriculitis with intravenous meropenem and intraventricular polymyxin B: case report and review. Clin Infect Dis. 1999;28:1134–8.

    Article  PubMed  CAS  Google Scholar 

  55. Quinn AL, Parada JP, Belmares J, et al. Intrathecal colistin and sterilization of resistant Pseudomonase aeruginosa shunt infection. Ann Pharmacother. 2005;39:949–52.

    Article  PubMed  Google Scholar 

  56. Aguilar J, Urday-Cornejo V, Donabedian S. Staphylococcus aureus meningitis: case series and literature review. Medicine. 2010;89:117–25. This is a retrospective review to help establish guidelines for the treatment of S. aureus meningitis.

    Article  PubMed  Google Scholar 

  57. Liu C, Bayer A, Cosgrove S, et al. Management of Patients with Infections Caused by Methicillin-Resistant Staphylococcus Aureus: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA). Clin Infect Dis. 2011;52:1–38. This is a review to establish the IDSA guidelines for patients with MRSA infections.

    Article  Google Scholar 

  58. Teh BW, Slavin MA. Staphylococcus aureus meningitis: barriers to treatment. Leuk Lymphoma. 2012;53:1443–4.

    Article  PubMed  Google Scholar 

  59. Lee DH, Palermo B, Chowdhury M. Successful treatment of methicillin-resistant Staphylococcus aureus meningitis with daptomycin. Clin Infect Dis. 2008;44:1356–8.

    Google Scholar 

  60. Bardak-Ozcem S, Turhan T, Sipahi OR, et al. Daptomycin versus vancomycin in treatment of methicillin-resistant Staphylococcus aureus meningitis in an experimental rabbit model. Antimicrob Agents Chemother. 2013;57:1556–8.

    Article  PubMed  CAS  Google Scholar 

  61. Wahby K, Alangaden GJ. Daptomycin failure in a neutropenic leukemia patient with Staphylococcus aureus meningitis. Leuk Lymphoma. 2012;53:1610–2.

    Article  PubMed  CAS  Google Scholar 

  62. Beringer P, Nguyen M, Hoem N, et al. Absolute bioavailability and pharmacokinetics of linezolid in hospitalized patients given enteral feedings. Antimicrob Agents Chemother. 2005;49:3676–81.

    Article  PubMed  CAS  Google Scholar 

  63. Weisfelt M, van de Beek D, Spanjaard L, et al. Community-acquired bacterial meningitis in older people. JAGS. 2006;54:1500–7.

    Article  Google Scholar 

  64. van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010;9:254–63. This is a meta-analysis to determine which patients benefit from dexamethasone therapy.

    Article  PubMed  Google Scholar 

  65. Nguyen TH, Tran TH, Thwaites G, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med. 2007;357:2431–40.

    Article  PubMed  CAS  Google Scholar 

  66. Scarborough M, Gordon SB, Whitty CJ, et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. N Engl J Med. 2007;357:2441–50.

    Article  PubMed  CAS  Google Scholar 

  67. Molyneux EM, Walsh AL, Forsyth H, et al. Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomized controlled trial. Lancet. 2002;360:211–18.

    Article  PubMed  CAS  Google Scholar 

  68. Brouwer MC, McIntyre P, de Gans J, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2010;9:CD004405.

    PubMed  Google Scholar 

  69. Hsu HE, Shutt KA, Moore MR, et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med. 2009;360:244–56.

    Article  PubMed  CAS  Google Scholar 

  70. Hicks LA, Harrison LH, Flannery B, et al. Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCY7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998–2004. J Infect Dis. 2007;196:1346–54.

    Article  PubMed  Google Scholar 

  71. Centers for Disease Control and Preventions. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816–9. This is a statement from the CDC to establish recommendations for vaccinations in adults.

    Google Scholar 

  72. Vila-Córcoles A, Ochoa-Gondar O, Guzmán JA, et al. Effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal disease in people 60 years or older. BMC Infect Dis. 2010;10:73–81.

    Article  PubMed  Google Scholar 

  73. O'Brien JA, Caro JJ, Getsios D. Managing meningococcal disease in the United States: Hospital case characteristics and costs by age. Value Health. 2006;9:236–43.

    Article  PubMed  Google Scholar 

  74. Stephens DS, Hajjeh RA, Baughman WS, et al. Sporadic meningococcal disease in adults: Results of a 5-year population-based study. Ann Intern Med. 1995;123:937–40.

    Article  PubMed  CAS  Google Scholar 

  75. Cohn AC, MacNeil JR, Harrison LH, et al. Changes in Neisseria meningitidis disease epidemiology in the United States, 1998–2007: Implications for prevention of meningococcal disease. Clin Infect Dis. 2010;50:184–91.

    Article  PubMed  Google Scholar 

  76. Stephens DS. Uncloaking the Meningococcus: dynamics of carriage and disease. Lancet. 1999;353:941–2.

    Article  PubMed  CAS  Google Scholar 

  77. CDC. Updated recommendations for use of meningococcal conjugate vaccines–Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep. 2011;60:72–6.

    Google Scholar 

  78. Macneil JR, Cohn AC, Zell ER, et al. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. Pediatr Infect Dis J. 2011;30:451–5. This study reports the early estimate of the vaccines effectiveness and the numbers of breakthrough disease.

    PubMed  Google Scholar 

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Conflict of Interest

Diedre Hofinger declares that she has no conflict of interest.

Larry E. Davis received compensation for reviewing a fatal case of bacterial meningitis (for his expert opinion) in a case that neverwent to trial, received lecturing honoraria fromtheAmerican Academy ofNeurology, and has received royalties from Demos Medical Publishing.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. From Internal Medicine and Infectious Disease Service, New Mexico VA Health Care System, 1501 San Pedro Dr. SE, Albuquerque, NM, 87108, USA

    Diedre Hofinger MD

  2. Department of Internal Medicine and Infectious Disease, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA

    Diedre Hofinger MD

  3. Neurology Service, New Mexico VA Health Care System, 1501 San Pedro Dr. SE, Albuquerque, NM, 87108, USA

    Larry E. Davis MD, FAAN

  4. Departments of Neurology and Neuroscience, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA

    Larry E. Davis MD, FAAN

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Correspondence to Diedre Hofinger MD.

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Hofinger, D., Davis, L.E. Bacterial Meningitis in Older Adults. Curr Treat Options Neurol 15, 477–491 (2013). https://doi.org/10.1007/s11940-013-0244-7

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