Non-pneumococcal Gram-positive coccal meningitis related to neurosurgery.

Thirty-eight of 154 cases (25%) of bacterial meningitis seen by the authors during a 7-year period were due to non-pneumococcal Gram-positive cocci. Thirty cases (80%) resulted from neurosurgical manipulation; half of these were shunt infections and half were early postoperative complications. Only three cases (8%) occurred de novo in patients with presumably normal host defenses. Signs, symptoms, and laboratory data related more to predisposing factors than to infecting microorganisms. Fever, peripheral leukocytosis, abnormal cerebrospinal fluid (CSF), and positive Gram stain were the most reliable indicators of infection. Prognosis was good with antibiotic therapy and removal of CSF shunt equipment when present.