Coagulase-negative staphylococci are associated to the mild inflammatory pattern of healthcare-associated meningitis: a retrospective study

Eur J Clin Microbiol Infect Dis. 2018 Apr;37(4):755-763. doi: 10.1007/s10096-017-3171-9. Epub 2018 Jan 20.

Abstract

The epidemiology of healthcare-associated meningitis (HAM) is dominated by commensal bacteria from the skin, as coagulase-negative staphylococci (CoNS). We hypothesized that the pauci-symptomatic and mild inflammatory patterns of HAM are related to the low pathogenic state of CoNS. Our aim was to describe clinical and biological features of CoNS HAM, compared to other HAM. All consecutive patients with HAM admitted in our hospital were retrospectively included from 2007 to 2014. HAM due to CoNS were compared to HAM caused by other bacteria (controls) for clinical and laboratory patterns. Seventy-one cases of HAM were included, comprising 18 CoNS and 53 controls. Patients were not different in terms of baseline characteristics. CoNS HAM occurred later after the last surgery than controls (17 vs. 12 days, p = 0.029) and had higher Glasgow Coma Scale (GCS) score (14 vs. 13, p = 0.038). Cerebrospinal fluid (CSF) analysis revealed a lower pleocytosis (25 vs. 1340/mm3, p < 0.001), a higher glucose level (3.75 vs. 0.8 mmol/L, p < 0.001), and a lower protein level (744 vs. 1751 mg/L, p < 0.001) in the CoNS group than in the control group, respectively. HAM due to CoNS was significantly less symptomatic and less inflammatory than HAM due to other bacteria.

MeSH terms

  • Adult
  • Bacteriological Techniques
  • Cerebrospinal Fluid / cytology
  • Cerebrospinal Fluid / microbiology
  • Coagulase
  • Cross Infection / cerebrospinal fluid
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Kaplan-Meier Estimate
  • Leukocytosis
  • Male
  • Meningitis, Bacterial / cerebrospinal fluid
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / microbiology*
  • Middle Aged
  • Retrospective Studies
  • Staphylococcal Infections / cerebrospinal fluid
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology*
  • Staphylococcus
  • Treatment Outcome

Substances

  • Coagulase