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Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by methicillin-resistant and methicillin-susceptible strains.
J Hosp Infect. 2018 Nov 15;:
Authors: Pintado V, Pazos R, Jiménez-Mejías ME, Rodríguez-Guardado A, Díaz-Pollán B, Cabellos C, García-Lechuz JM, Lora-Tamayo J, Domingo P, Muñez E, Domingo D, González-Romo F, Lepe-Jiménez JA, Rodríguez-Lucas C, Gil A, Pelegrín I, Chaves F, Pomar V, Ramos A, Alarcón T, Pérez-Cecilia E
Abstract
BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures but spontaneous infections may occasionally appear.
AIMS: To compare the features of meningitis caused by methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy.
METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyze prognostic factors.
RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs. 73%) and nosocomial acquisition (93% vs. 74%) were significantly more frequent in MRSA than in MSSA meningitis (P<0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio [OR], 9.9 [95% CI, 4.5-22.0], P<0.001), spontaneous meningitis (OR, 4.2 [95% CI, 1.9-9.1], P<0.001), McCabe-Jackson score rapidly or ultimately fatal (OR, 2.8 [95% CI, 1.4-5.4], P=0.002), MRSA infection (OR, 2.6 [95% CI, 1.3-5.3], P=0.006), and coma (OR, 2.6 [95% CI, 1.1-6.1], P<0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR, 7.9 [95% CI, 3.1-20.3], P<0.001).
CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.
PMID: 30448277 [PubMed - as supplied by publisher]