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Kim, Moon, Park, Suh, and Lee: Clinical Aspects of Bacterial Meningitis in Cerebrospinal Fluid Culture Positive Patients in a Tertiary Care University Hospital
Original Article

Korean J Clin Microbiol 2011;14(1):1-6.

Published online: 21 March 2011

DOI: https://doi.org/10.5145/KJCM.2011.14.1.1

Clinical Aspects of Bacterial Meningitis in Cerebrospinal Fluid Culture Positive Patients in a Tertiary Care University Hospital

Min Jin Kim1, Song Mi Moon2, Tae Sung Park1, Jin-Tae Suh1, Hee Joo Lee1

1Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea

2Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Hee Joo Lee, Department of Laboratory Medicine, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea. (Tel) 82-2-958-8672, (Fax) 82-2-958-8609, (E-mail) leehejo@khmc.or.kr

Received 4 May 2010       Revised 28 June 2010       Accepted 20 July 2010

Copyright © 2011 Korean Journal of Clinical Microbiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

There have been previous clinical research studies on clinical manifestations of meningitis in adults or children; however, few have focused on including both groups and none on the causative organism and its susceptibilities to antibiotics. Here we describe the distribution of causative organism and its antibiotic susceptibilities of meningitis from spinal fluid positive patients of a university hospital.

Methods

Cases of spinal fluid culture results from admitted patients in Kyung Hee Medical Center from July 2004 to June 2009 were analyzed retrospectively by their medical records and laboratory results.

Results

Ninety five cases of positive spinal fluid culture results were obtained and 25 cases fit the diagnostic criteria for bacterial meningitis. 5 cases were spontaneous meningitis and 20 were post cranial surgery meningitis. Among the 25 patients, fever was the most common clinical presentation (100%) and ven-triculoperitoneal shunt was the most common causative procedure of post cranial surgery meningitis. Streptococcus pneumoniae for spontaneous meningitis and Acinetobacter species for post cranial surgery meningitis was identified as the most common causative organisms.

Conclusion

Recurrent positive spinal fluid culture results of the same organism was found in expired patients due to post cranial surgery meningitis and also from the culture results of the wound and intra-cranial inserted instruments, suggesting post operative infection control is directly related to morbidity requiring adequate usage of antibiotics rather than empirical broad spectrum antibiotics.

Keywords: Bacterial meningitis, CSF, Antibiotic susceptibilities of meningitis, Spinal fluid culture

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Table 1.
Ninety-five cases of cerebrospinal fluid culture-positive bacteria
Gram positive bacteria 76
Staphylococcus aureus, MSSA 1
Staphylococcus aureus, MRSA 7
Coagulase negative staphylococcus 35
Streptococcus viridans, α-hemolytic 2
Streptococcus pneumoniae 7
Streptococcus salivarius 2
Streptococcus, non-hemolytic 1
Micrococcus species 3
Enterococcus species 6
Bacillus species 11
Enterococcus faecalis+Staphylococcus aureus 1
Gram negative bacteria 19
Acinetobacter baumannii 4
Klebsiella pneumoniae 6
Enterobacter species 3
Flavobacterium species 2
Pseudomonas aeruginosa 2
Citrobacter freundii 1
Non-fermenting gram negative rods 1
Total 95
Table 2.
Causative organisms of the 25 bacterial meningitis cases
Pathogen Spontaneous meningitis P (n=5) Postneurosurgical meningitis (n=20)
Gram-negative pathogens    
 Klebsiella pneumoniae 0 2
 Pseudomonas species 0 1
 Acinetobacter species 0 4
 Enterobacter species 0 2
 Flavobacterium species 0 1
Gram-positive pathogens    
 Staphylococcus aureus 0 3
 Coagulase-negative staphylococci 0 3
 Streptococcus species 5 2
 Enterococcus species 0 2
Table 3.
Cerebrospinal fluid finding of bacterial meningitis
Test Spontaneous meningitis (n=5) Postneurosurgical meningitis (n=20) P value
Mean Range Mean Range
WBC (/mm3) 4,902 800∼8,480 6,568 20∼65,850 0.772
Neutrophil (%) 82 69∼95 72 46∼100 0.835
Lymphocyte (%) 7 1∼14 9 0∼27  
Protein (mg/dL) 218.8 131∼270 658.5 14∼5,700 0.164
Glucose (mg/dL) 39.4 23∼73 23.4 0∼79 0.468
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