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

2019-05Journal article Restricted access
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dc.contributor.authorPintado, V
dc.contributor.authorPazos, Rosario
dc.contributor.authorJimenez-Mejias, M. E.
dc.contributor.authorRodriguez-Guardado, A.
dc.contributor.authorDiaz-Pollan, B.
dc.contributor.authorCabellos, C.
dc.contributor.authorGarcia-Lechuz, J. M.
dc.contributor.authorLora-Tamayo, J.
dc.contributor.authorDomingo, P.
dc.contributor.authorMunez, E.
dc.contributor.authorDomingo, D.
dc.contributor.authorGonzalez-Romo, F.
dc.contributor.authorLepe-Jimenez, J. A.
dc.contributor.authorRodriguez-Lucas, C.
dc.contributor.authorGil, A.
dc.contributor.authorPelegrin, I
dc.contributor.authorChaves, F.
dc.contributor.authorPomar, V
dc.contributor.authorRamos, A.
dc.contributor.authorAlarcon, T.
dc.contributor.authorPerez-Cecilia, E.
dc.date.accessioned2020-07-24T10:52:26Z
dc.date.available2020-07-24T10:52:26Z
dc.date.issued2019-05
dc.description.abstractBackground: 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. (C) 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
dc.description.versioninfo:eu-repo/semantics/publishedVersion
dc.identifier.doi10.1016/j.jhin.2018.11.008
dc.identifier.issn0195-6701
dc.identifier.issn1532-2939
dc.identifier.urihttp://hdl.handle.net/10400.1/14360
dc.language.isoeng
dc.peerreviewedyes
dc.publisherW B Saunders Co Ltd
dc.subjectClinical-practice guidelines
dc.subjectNervous-system infections
dc.subjectMethicillin-resistant
dc.subjectBacterial-meningitis
dc.subjectAntimicrobial resistance
dc.subjectDiseases society
dc.subjectRisk-factors
dc.subjectBacteremia
dc.subjectNationwide
dc.subjectDefinitions
dc.titleStaphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage115
oaire.citation.issue1
oaire.citation.startPage108
oaire.citation.titleJournal of Hospital Infection
oaire.citation.volume102
rcaap.rightsrestrictedAccess
rcaap.typearticle

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