[Acute bacterial meningitis in older people]. / Meningitis aguda bacteriana en ancianos.

INTRODUCTION: The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients. MATERIAL AND METHODS: We reviewed the meningitis cases diagnosed at our hospital (1982-2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged > or =60) and young adults (aged 14-59). RESULTS: Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often (p=0,002), had higher protein level (p=0,023) and higher percentage of positive cerebrospinal fluid culture (p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common (p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age > or =years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age > or =75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality. CONCLUSIONS: In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications.

Meningitis aguda bacteriana en ancianos / Acute bacterial meningitis in older people

Introducción La distribución de la meningitis aguda bacteriana (MAB) se ha desplazado de la infancia a la edad adulta, mientras crece la proporción de ancianos en la población. El objetivo es describir la MAB en ancianos. Material y métodos Estudio de las meningitis diagnosticadas en nuestro hospital entre 1982–2006, incluyendo las que cumplieron criterios diagnósticos de MAB, clasificándolas en dos grupos: ancianos (≥60 años) y adultos (14–59 años). Resultados Noventa y cinco de 239 MAB (40%) ocurrieron en ancianos y 144 (60%) en adultos. En ancianos, 32% fueron nosocomiales y 49% tuvieron factores de riesgo posoperatorios, siendo espontáneas 24%. El 45% presentaron fiebre, alteración de conciencia y signos meníngeos, cursando más frecuentemente con alteración de conciencia (p=0,002), cifras más elevadas de proteínas (p=0,023) y cultivo positivo de líquido cefalorraquídeo (p=0,039). Los patógenos más comunes fueron Streptococcus pneumoniae (20%), Staphylococcus coagulasa negativo (14%) y Listeria monocytogenes (8%), mientras que la etiología desconocida fue menos frecuente (p=0,014). La mortalidad fue superior (19% vs. 6%; p=0,001), relacionándose con: edad ≥75 años, alteración de conciencia, ausencia de cefalea y vómitos, desarrollo de complicaciones y de complicaciones sistémicas, y etiología por Staphylococcus aureus. En el análisis multivariante, la edad ≥75 años [OR=6,65; p=0,008] y el desarrollo de complicaciones [OR=4,55, p=0,015] permanecieron asociadas a mortalidad, y la cefalea a curación [OR=0,15; p=0,003]. Conclusiones La MAB en ancianos ocurre en presencia de factores de riesgo y la etiología más común es S. pneumoniae. Su mortalidad, superior a la de los adultos, se asocia a la edad y al desarrollo de complicaciones(AU)

Introduction The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients. Material and methods We reviewed the meningitis cases diagnosed at our hospital (1982–2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged ≥60) and young adults (aged 14–59). Results Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often (p=0,002), had higher protein level (p=0,023) and higher percentage of positive cerebrospinal fluid culture (p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common (p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age ≥75 years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age ≥75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality. Conclusions In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications(AU)

[Comparative study of meningitis due to Staphylococcus aureus and coagulase-negative Staphylococci in adults]. / Estudio comparativo de las meningitis por Staphylococcus aureus y Staphylococci coagulasa negativo en adultos.

INTRODUCTION: Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they are a frequent cause of nosocomial meningitis. AIMS. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults. PATIENTS AND METHODS: We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp. RESULTS: Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoN Staphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent in infections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%). CONCLUSIONS: Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially in the post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus.

Estudio comparativo de las meningitis por Staphylococcus aureus y Staphylococci coagulasa negativos en adultos / Comparative study of meningitis due to staphylococcus aureus and coagulase-negative staphylococci in adults

Introducción. Los Staphylococcus spp. raramente causan meningitis aguda bacteriana (MAB) comunitaria, pero sonuna etiología frecuente de meningitis nosocomial. Objetivo. Descripción y análisis comparativo de MAB por S. aureus y Staphylococci coagulasa negativos (CoN) en adultos. Pacientes y métodos. Revisión del historial de pacientes de edad igual o superior a 14 años diagnosticados de MAB, incluyendo aquéllos con cultivo de líquido cefalorraquídeo (LCR) positivo paraStaphylococcus spp. Resultados. Se incluyen 40 casos (el 28% de las MAB), 12 por S. aureus y 28 por Staphylococci CoN. La incidencia aumentó en el tiempo: el 1,9% en el primer tercio del estudio, el 22,9% en el segundo y el 19,4% en el tercero (p = 0,003). El 67% fue nosocomial y el 95%, postoperatorio. Los dispositivos neuroquirúrgicos (74%) y la neurocirugía reciente(26%) fueron los factores de riesgo, y ambos se asociaron en el 61%. La clínica y alteraciones del LCR fueron similares en ambos grupos, pero en infecciones por S. aureus fue más frecuente la bacteriemia (60% frente a 20%) y el desarrollo de complicaciones(50% frente a 11%). La mortalidad global fue del 15%, superior en infecciones por S. aureus (67% frente a 0%). La mortalidad se asoció también a adquisición espontánea de la infección (25% frente a 0%), desarrollo de complicaciones sépticas (37% frente a 6%), bacteriemia (62% frente a 19%) y no retirar o sustituir el dispositivo neuroquirúrgico (60% frente a 0%).Conclusiones. Los Staphylococcus spp. son una etiología frecuente de MAB en hospitales con neurocirugía, especialmente en el postoperatorio neuroquirúrgico y/o en portadores de dispositivos de drenaje del LCR. El pronóstico en infecciones por Staphylococci CoN es favorable, frente a la elevada mortalidad causada por S. aureus

Introduction. Staphylococcus spp. rarely cause community-acquired acute bacterial meningitis (ABM), but they area frequent cause of nosocomial meningitis. Aims. We describe and conduct a comparative analysis of ABM due to S. aureus and coagulase-negative (CoN) Staphylococci in adults. Patients and methods. We reviewed the medical records of patients aged 14 or over who had been diagnosed with ABM, including those with a positive cerebrospinal fluid (CSF) culture for Staphylococcus spp. Results. Forty cases were included (28% of the ABM), 12 due to S. aureus and 28 due to CoNStaphylococci. Incidence increased over time: 1.9% in the first third of the study, 22.9% in the second and 19.4% in the third (p = 0.003). In 67% of cases it was nosocomial and post-operative in 95%. Neurosurgical devices (74%) and recent neurosurgery (26%) were the risk factors, and both associated 61%. Clinical signs and symptoms and alterations to CSF were similar in both groups, but bacteraemia (60% versus 20%) and the development of complications were more frequent ininfections due to S. aureus. Overall mortality rate was above 15%, and was higher in infections due to S. aureus (67% versus 0%). Mortality was also associated with spontaneous acquisition of the infection (25% versus 0%), the development of septic complications (37% versus 6%), bacteraemia (62% versus 19%) and not withdrawing or changing the neurosurgical device (60% versus 0%). Conclusions. Staphylococcus spp. are a frequent cause of ABM in hospitals with neurosurgery, especially inthe post-operative period following neurosurgical procedures and/or in carriers of CSF drainage devices. Prognosis in infections caused by CoN Staphylococci is favourable, in contrast to the high mortality rate caused by S. aureus

Mujer de 36 años con tumoración quística pancreática y trombopenia / 36-year old woman with cystic pancreatic tumor and thrombopenia

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