Staphylococcus aureus meningitis in adults: a clinical comparison of infections caused by methicillin-resistant and methicillin-sensitive strains.

Abstract

This study was undertaken to compare the clinical characteristics of adult methicillin-sensitive Staphylococcus aureus (MSSA) meningitis and adult methicillin-resistant S. aureus (MRSA) meningitis. The clinical characteristics and therapeutic outcomes of 19 adult patients with S. aureus meningitis, including eight with MSSA infections and 11 with MRSA infections, were analyzed. A comparison was made between the clinical data of the patients with MSSA infections and those with MRSA infections. Before the end of 1995, MSSA infection was involved in all the adult patients with S. aureus meningitis but thereafter, MRSA infection was involved in 79% of the cases. The clinical characteristics found in patients with MSSA infection included underlying medical disorders (75%), community-acquired infection (75%) and mortality rate (13%). The clinical characteristics found in patients with MRSA infection included post-neurosurgical states (91%), nosocomial infections (100%), men outnumbering women (8:3), hydrocephalus (36%) and mortality rate (56%). Comparative study between the patient groups (hematogenous and post-neurosurgical) showed that only the mode of acquisition of infection had statistical significance. This study showed an increase in MRSA infections in adult S. aureus meningitis in recent years. The clinical characteristics of patients with MSSA and MRSA meningitis were different. Community-acquired infection was common in hematogenous S. aureus meningitis, while nosocomial infection was common in post-neurosurgical S. aureus meningitis. Vancomycin should be considered as one of the drugs of choice for initial therapy of adult bacterial meningitis, especially in post-neurosurgical patients.