Journal of the Neurological Sciences 182 (2000) 36–44 www.elsevier.com / locate / jns Adult bacterial meningitis in southern Taiwan: epidemiologic trend and prognostic factors a, a b * Cheng-Hsien Lu , Wen-Neng Chang , Hsueh-Wen Chang a Department of Neurology, Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan b Department of Biology, National Sun Yat-Sen University, Taiwan Received 29 November 1999; received in revised form 29 August 2000; accepted 15 September 2000 Abstract In two investigative phases over a 13.5-year study period (January 1986–June 1999), 202 adult patients with culture-proven bacterial meningitis were enrolled in this study. In order to determine the epidemiologic trend, prognostic factors and therapeutic results for this disease. Klebsiella pneumoniae ( K. pneumoniae), Pseudomonas aeruginosa, and Streptococcus pneumoniae were the three most commonly revealed pathogens, accounting for about 48% of the episodes. Although there was a change in relative frequency for the pathogens, K. pneumoniae remained the most prevalent during the two periods studied (January 1986–December 1992 and January 1993–June 1999). Multiantibiotic resistant strains have been in evidence since their appearance in 1994, with most of our patients acquiring their infection nosocomially. The overall mortality rates during the two periods were 40% and 34%, respectively. In stepwise logistic regression analysis, only initial conscious level, appropriate antibiotic therapy and septic shock were independently associated with mortality, after adjustment for other potentially confounding factors. Initial empirical antibiotics with both third-generation cephalosporin and penicillin G, should be considered for the majority of meningitis cases resulting from infection with Gram-negative bacilli and streptococcal species. Besides the evolution of newer pathogens, there has been increasing incidence for nosocomially acquired bacterial meningitis for patients postneurosurgery, with the emergence of resistant strains presenting a therapeutic challenge in recent years. Vancomycin and imipenem/cilastatin should be considered as the initial empirical antibiotics of choice for the treatment of this special group of patients.  2000 Elsevier Science B.V. All rights reserved. Keywords: Adult bacterial meningitis; Epidemiologic trends; Prognostic factors; Therapeutic results 1. Introduction investigated patients with ‘culture-negative’ bacterial men- ingitis, accounting for about 10% overall episodes [1,7]. Despite the step-by-step emergence of new antibiotics, Without definite CSF and / or blood culture results, how- acute bacterial meningitis is still a potentially fatal disease ever, initial CSF features may be misinterpreted resulting [1]. For research on the disease, most large studies have in the possible over-diagnosis of acute bacterial meningitis focused on either children and adults together, or children [9]. In this study, we focused on the relative frequency for exclusively [2–6], however, few workers have examined each bacteriological pathogen, for 202 adult patients with both clinical and pathological features for adult popula- culture-proven bacterial meningitis. In order to discover tions [1,7,8]. Further, some epidemiological studies have the factors that may significantly influence prognosis, we investigated the differences between nosocomially and community-acquired meningitis, predisposing factors, *Corresponding author. Tel.: 1886-7-731-7123, ext. 2283; fax: 1886- clinical and laboratory findings, and complications and 7-731-8762. E-mail address: chlu99@ms44.url.com.tw (C.-H. Lu). effects of antimicrobial therapy. This research was con- 0022-510X / 00 / $ – see front matter  2000 Elsevier Science B.V. All rights reserved. PII: S0022-510X(00)00445-7