Clinical manifestations, causative pathogens and treatment outcomes of patients with bacterial meningitis at a general hospital in eastern Thailand
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Abstract
Bacterial meningitis is a severe infection with significant morbidity and mortality. This study aimed to analyze causative pathogens, empirical therapy, antibiotic susceptibility, neurological sequelae and mortality rate in patients with bacterial meningitis. The study design was a retrospective, descriptive study. Patient eligibility criteria were the following: individuals diagnosed with bacterial meningitis according to the International Classification of Diseases (ICD)-10 codes from January 2014 to December 2017 at Sa Kaeo Crown Prince Hospital. A total of 99 patients with bacterial meningitis were identified, and 29% exhibited the classic triad (fever, drowsiness and neck stiffness). The causative pathogens were detected from blood or cerebrospinal fluid (CSF) in 40% and 6.1% of patients, respectively. The most common pathogens were Streptococcus spp. (10 patients), followed by Streptococcus suis (7 patients) and group D streptococcus (7 patients). Empirical therapy with monotherapy was mainly either ceftriaxone or cefotaxime (69.7%); however, the cephalosporin-resistant strain was 20.8%. Clinical outcomes included the 14-day mortality rate and neurological sequelae in 3% and 26.3% of patients, respectively. Pneumonia, septic shock and low CSF glucose concentration were significantly associated with unfavorable outcomes. Consequently, the most causative pathogen was Streptococcus spp., which was the third-generation cephalosporin-resistant strain. Third-generation cephalosporins plus vancomycin should be considered as an empirical therapy regimen.
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