Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains

J Hosp Infect. 2019 May;102(1):108-115. doi: 10.1016/j.jhin.2018.11.008. Epub 2018 Nov 16.

Abstract

Background: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear.

Aims: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy.

Methods: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors.

Results: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001).

Conclusions: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.

Keywords: Antimicrobial therapy; Meningitis; Meticillin-resistant; Meticillin-susceptible; Mortality; Staphylococcus aureus.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Cross Infection / pathology
  • Female
  • Hospitals
  • Humans
  • Male
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / microbiology
  • Meningitis, Bacterial / mortality
  • Meningitis, Bacterial / pathology
  • Methicillin Resistance*
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Spain / epidemiology
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / mortality
  • Staphylococcal Infections / pathology
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / isolation & purification*
  • Survival Analysis
  • Young Adult

Substances

  • Anti-Bacterial Agents