Generic Portal

TY - JOUR

T1 - Community-acquired Staphylococcus aureus meningitis in adults

AU - DASGIB study group

AU - van Soest, Thijs M

AU - Søndermølle, Maria Birgitte

AU - Brouwer, Matthijs C

AU - Chekrouni, Nora

AU - Larsen, Anders Rhod

AU - Petersen, Andreas

AU - van Sorge, Nina M

AU - Nielsen, Henrik

AU - van de Beek, Diederik

AU - Bodilsen, Jacob

N1 - Funding Information: Funding. This work was supported by the Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi Grant [grant number 917.17.308 to M. B.], NWO-Vici-Grant [grant number 918.19.627 to D. B.]); the Academic Medical Center (AMC Fellowship to D. B.); and the European Research Council (ERC Consolidator grant to M.C.B., ERC Starting grant to D. B.). The Netherlands Reference Laboratory for Bacterial Meningitis is supported by the National Institute of Public health and the Environmental Protection, Bilthoven. Funding Information: Funding. This work was supported by the Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi Grant [grant number 917.17.308 to M. B.], NWO-Vici-Grant [grant number 918.19.627 to D. B.]); the Academic Medical Center (AMC Fellowship to D. B.); and the European Research Council (ERC Consolidator grant to M.C.B. ERC Starting grant to D. B.). The Netherlands Reference Laboratory for Bacterial Meningitis is supported by the National Institute of Public health and the Environmental Protection, Bilthoven. Potential conflicts of interest. N.M. van Sorge receives consultancy fees from MSD, and GSK (fees paid to Amsterdam UMC); H. Nielsen received consultancy fees from GSK and MSD outside the submitted work. In addition, N.M. van Sorge has a patent WO 2013/020090 A3 (inventors: N.M. van Sorge/V. Nizet) outside the submitted work with royalties paid to University of California San Diego. Other authors: no conflicts of interest Publisher Copyright: © 2023 The British Infection Association

PY - 2023/3

Y1 - 2023/3

N2 - Background: Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease. Methods: We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics. Results: We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found. Conclusions: Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.

AB - Background: Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease. Methods: We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics. Results: We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found. Conclusions: Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.

KW - Clinical characteristics

KW - Community-acquired bacterial meningitis

KW - Outcome

KW - Prospective cohort study

KW - Staphylococcus aureus

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85147231884&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/36682629

U2 - 10.1016/j.jinf.2023.01.022

DO - 10.1016/j.jinf.2023.01.022

M3 - Article

C2 - 36682629

VL - 86

SP - 239

EP - 244

JO - Journal of infection

JF - Journal of infection

SN - 0163-4453

IS - 3

ER -