Background and Methods To characterize acute bacterial meningitisin adults, we reviewed the charts of all persons 16 years ofage or older in whom acute bacterial meningitis was diagnosedat Massachusetts General Hospital from 1962 through 1988. Weincluded patients who were admitted after initial treatmentat other hospitals.
Results During the 27-year period, 445 adults were treated for493 episodes of acute bacterial meningitis, of which 197 (40percent) were nosocomial. Gram-negative bacilli (other thanHaemophilus influenzae) caused 33 percent of the nosocomialepisodes but only 3 percent of the community-acquired episodes.In the 296 episodes of community-acquired meningitis, the mostcommon pathogens were Streptococcus pneumoniae (37 percent),Neisseria meningitidis (13 percent), and Listeria monocytogenes(10 percent); these organisms accounted for only 8 percent ofthe nosocomial episodes. Only 19 of the 493 episodes of meningitis(4 percent) were due to H. influenzae. Nine percent of all patientshad recurrent meningitis; many had a cerebrospinal fluid leak.Seizures occurred in 23 percent of patients with community-acquiredmeningitis, and 28 percent had focal central nervous systemfindings. Risk factors for death among those with single episodesof community-acquired meningitis included older age ( 60 years),obtunded mental state on admission, and seizures within thefirst 24 hours. Among those with single episodes, the in-hospitalmortality rate was 25 percent for community-acquired and 35percent for nosocomial meningitis. The overall case fatalityrate was 25 percent and did not vary significantly over the27 years.
Conclusions In our large urban hospital, a major proportionof cases of acute bacterial meningitis in adults were nosocomial.Recurrent episodes of meningitis were frequent. The overallmortality rate remained high.
Source Information
From the Infectious Disease Unit (M.L.D., S.B.C., D.J.W., S.I.M., F.S.S., M.N.S.) and the Neurology Department (V.S.C.), Massachusetts General Hospital, Boston.
Address reprint requests to Dr. Durand at the Infectious Disease Unit, Massachusetts General Hospital, Fruit St., Boston, MA 02114.
Acute Bacterial Meningitis in Adults
Martinez E., Marcos A., Brivet F. G., Guibert M., Dormont J., Durand M. L., Calderwood S. B., Swartz M. N.
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N Engl J Med 1993;
328:1712-1713, Jun 10, 1993.
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A correction has been published: N Engl J Med 1993;328(23):1712.
60 years), obtunded mental state on admission, and seizures within the first 24 hours. Among those with single episodes, the in-hospital mortality rate was 25 percent for community-acquired and 35 percent for nosocomial meningitis. The overall case fatality rate was 25 percent and did not vary significantly over the 27 years. 
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