Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases.

BACKGROUND

Haematogenous Staphylococcus aureus meningitis is rare but associated with high mortality. Knowledge about the disease is still limited. The objective of this study was to evaluate demographic and clinical prognostic features of bacteraemic S. aureus meningitis.

METHODS

Nationwide surveillance in Denmark from 1991 to 2000 with clinical and bacteriological data. Risks of death were estimated by Cox proportional hazards regression analysis.

RESULTS

Among 12480 cases of S. aureus bacteraemia/sepsis, we identified 96 cases of non-surgical bacteraemic S. aureus meningitis (0.8%). Incidence rates were 0.24 (95% confidence interval [CI], 0.18 to 0.30)/100,000 population between 1991-1995 and 0.13 (CI, 0.08 to 0.17)/100,000 population between 1996-2000. Mortality was 56%. After adjustment, only co morbidity (hazard ratio [HR], 3.45; CI, 1.15 to 10.30) and critical illness (Pitt score > or = 4) (HR, 2.14; CI, 1.09 to 4.19) remained independent predictors of mortality.

CONCLUSION

The incidence, but not mortality of bacteraemic S. aureus meningitis decreased during the study period. Co morbidity and critical illness were independent predictors of a poor outcome.