V Pintado1, R Pazos2, M E Jiménez-Mejías3, A Rodríguez-Guardado4, B Díaz-Pollán5, C Cabellos6, J M García-Lechuz7, J Lora-Tamayo8, P Domingo9, E Muñez10, D Domingo11, F González-Romo12, J A Lepe-Jiménez3, C Rodríguez-Lucas4, A Gil5, I Pelegrín6, F Chaves13, V Pomar9, A Ramos10, T Alarcón11, E Pérez-Cecilia12. 1. Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. Electronic address: vpintado.hrc@salud.madrid.org. 2. Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Biomedical Sciences and Medicine, Universidade do Algarve, Faro, Portugal. 3. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain. 4. Infectious Diseases Unit, Hospital Central de Asturias, Oviedo, Spain. 5. Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain. 6. Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain. 7. Clinical Microbiology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain; Department of Clinical Microbiology, Hospital Gregorio Marañon, Madrid, Spain. 8. Internal Medicine Department, Hospital 12 de Octubre, Madrid, Spain. 9. Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 10. Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain. 11. Microbiology Service, Hospital de La Princesa, Madrid, Spain. 12. Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain. 13. Clinical Microbiology Department, Hospital 12 de Octubre, Madrid, Spain.
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.
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.