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Cited by 74Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingInfectious Diseases and Tuberculosis

The spectrum of acute bacterial meningitis in elderly patients

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Domingo, Pere, Pomar, Virginia, de Benito, Natividad, Coll, Pere·2013·BMC Infectious Diseases
DOI 10.1186/1471-2334-13-108PMC PMC3599144
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Abstract

BACKGROUND: We conducted a prospective, observational study in Barcelona to determine the epidemiology, clinical features, and outcome of elderly patients with acute bacterial meningitis (ABM) compared with younger adults. METHODS: During 1982-2010, all patients with ABM were prospectively evaluated. There were two groups: I (15-64 years) and II (≥ 65 years). All patients underwent clinical examination on admission and at discharge following a predefined protocol. RESULTS: We evaluated 635 episodes of ABM. The incidence was 4.03/100,000 (Group I) and 7.40 /100,000 inhabitants/year (Group II) (RR = 1.84; 95%CI: 1.56-2.17, P < 0.0001). Elderly patients had co-morbid conditions more frequently (P < 0.0001) and more frequently lacked fever (P = 0.0625), neck stiffness (P < 0.0001) and skin rash (P < 0.0001), but had an altered level of consciousness more often (P < 0.0001). The interval admission-start of antibiotic therapy was longer for elderly patients (P < 0.0001). Meningococcal meningitis was less frequent in elderly patients (P < 0.0001), whereas listerial (P = 0.0196), gram-negative bacillary (P = 0.0065), and meningitis of unknown origin (P = 0.0076) were more frequent. Elderly patients had a higher number of neurologic (P = 0.0009) and extra-neurologic complications (P < 0.0001). The overall mortality ratio was higher in elderly patients (P < 0.0001). CONCLUSIONS: Elderly people are at higher risk of having ABM than younger adults. ABM in the elderly presents with co-morbid conditions, is clinically subtler, has a longer interval admission-antibiotic therapy, and has non-meningococcal etiology. It is associated with an earlier and higher mortality rate than in younger patients.

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  • Enterobacteriaceae such as E. coli and rarely Listeria monocytogenes, Haemophilus influenzae, Streptococcus agalactiae, Staphylococcus aureus are associated with mortality estimates ranging from 30% to 60%.

    “These include Enterobacteriaceae such as E. coli and rarely Listeria monocytogenes, Haemophilus influenzae, Streptococcus agalactiae, Staphylococcus aureus, 22 which are associated with mortality estimates ranging from 30% to 60%.7,22,23”

    From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [22]

    The Results (CSF findings, microbiologic features and etiology) identify all the named organisms among the meningitis cases. But Listeria was more frequent in elderly patients, not described as rare, and the Results (Evolving features and outcome) give mortality of 0% for elderly patients with H. influenzae meningitis and 31.0% for the combined listerial/gram-positive-bacilli category. The claimed 30%–60% range therefore does not hold for every organism listed. (LLM, conf=0.89)

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Authors
Domingo, P., Pomar, V., de Benito, N., & Coll, P.
Affiliations
Universitat Autònoma de Barcelona (ES)
ORCID
Venue
BMC Infectious Diseases
Publisher
Springer Science and Business Media LLC
Published
2013-02-27
Volume
13
Issue
1
Pages
108-108
ISSN
1471-2334 (ISSN-L)
DOI
10.1186/1471-2334-13-108
PMC
PMC3599144
OpenAlex
W1996610887
Cited by
74
References
49
Citations by year
2026: 2 · 2025: 3 · 2024: 1 · 2023: 8 · 2022: 4 · 2021: 6 · 2020: 8 · 2019: 6 · 2018: 7 · 2017: 5 · 2016: 12 · 2015: 5 · 2014: 4 · 2013: 3
FWCI
7.34
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Infectious Diseases (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
Funders
Instituto de Salud Carlos III (INT12/383)
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords
acute bacterial meningitis, elderly patients, incidence, clinical features, comorbidities, mortality, Listeria meningitis, gram-negative bacillary meningitis, meningococcal meningitis, complications, age differences
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Anti-Bacterial Agents, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Spain, Comorbidity, Chi-Square Distribution, Survival Analysis, Treatment Outcome, Meningitis, Bacterial

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