Meningitis: prevalence, cause and outcome.

Clinical bottom line (level 4)

  1. Two thirds of patients with bacterial meningitis had community-acquired meningitis, and a third had nosocomial meningitis.
  2. A quarter of patients with bacterial meningitis were infected by Streptococcus pneumoniae.
  3. Two thirds of patients with community-acquired meningitis had all three classic signs of fever, neck stiffness and altered mental status.
  4. Nearly a quarter of patients had seizures.
  5. A fifth of the deaths were meningitis-related.
Durand et al: New England Journal of Medicine 1993; 328: 21-28
Expires November 2003

The study

Setting: general hospital, USA

445 patients (aged ?, ?% male) diagnosed acute bacterial meningitis in the hospital between January 1962 and December 1988

Excluded if
  • <16 years old



    • There were 493 episodes of meningitis in the 445 patients.

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    community-acquired meningitis 275 61.8%
    (57.3% to 66.3%)
    nosocomial meningitis 175 39.3%
    (34.8% to 43.9%)
    infection caused by streptococcus pneumoniae 118 23.9%
    (20.2% to 27.7%)
    infection caused by N. meningitidis 35 7.10%
    (4.80% to 9.40%)
    infection caused by listeria monocytogenes 34 6.90%
    (4.70% to 9.10%)
    infection caused by Gram-negative bacilli 104 21.1%
    (17.5% to 24.7%)
    community-acquired meningitis with classic triad of fever, neck stiffness and altered mental status 184 65.9%
    (60.4% to 71.5%)
    seizures 113 22.9%
    (19.2% to 26.6%)
    meningitis-related mortality 94 19.1%
    (15.6% to 22.5%)

    Comments

    1. The inclusion of nosocomial disease and a very long period of analysis (from 1962 onwards) must be taken into account.

    Citation

    1. Durand ML, Calderwood SB, Weber DJ, et al: Acute bacterial meningitis in adults: A review of 493 episodes. New England Journal of Medicine 1993; 328: 21-28
    Contributor: Clare Wotton and Bob Phillips, November 1999
    Reviewer: Padmanabhan Badrinath

    Clinical Question.
    Patient population in the USA
    Intervention or Exposure how many cases of meningitis
    Comparison with no meningitis
    Outcome in the community