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Research Article| Volume 86, ISSUE 3, P239-244, March 2023

Community-acquired Staphylococcus aureus meningitis in adults

  • Author Footnotes
    1 These authors contributed equally to this work.
    Thijs M. van Soest
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands

    Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands

    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Maria Birgitte Søndermølle
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland

    Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
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  • Matthijs C. Brouwer
    Affiliations
    Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands

    Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands

    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
    Search for articles by this author
  • Nora Chekrouni
    Affiliations
    Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands

    Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands

    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
    Search for articles by this author
  • Anders Rhod Larsen
    Affiliations
    Statens Serum Institut, Copenhagen, Denmark
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  • Andreas Petersen
    Affiliations
    Statens Serum Institut, Copenhagen, Denmark
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  • Nina M. van Sorge
    Affiliations
    Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands

    Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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  • Henrik Nielsen
    Affiliations
    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland

    Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
    Search for articles by this author
  • Author Footnotes
    3 These authors contributed equally to this work.
    Diederik van de Beek
    Footnotes
    3 These authors contributed equally to this work.
    Affiliations
    Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands

    Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands

    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
    Search for articles by this author
  • Author Footnotes
    3 These authors contributed equally to this work.
    Jacob Bodilsen
    Correspondence
    Corresponding author at: Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark.
    Footnotes
    3 These authors contributed equally to this work.
    Affiliations
    European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland

    Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
    Search for articles by this author
  • DASGIB study group
    Author Footnotes
    2 Study group members are listed in the appendix.
  • Author Footnotes
    1 These authors contributed equally to this work.
    2 Study group members are listed in the appendix.
    3 These authors contributed equally to this work.
Published:January 19, 2023DOI:https://doi.org/10.1016/j.jinf.2023.01.022
Community-acquired Staphylococcus aureus meningitis in adults
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      Summary

      Background

      Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease.

      Methods

      We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics.

      Results

      We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found.

      Conclusions

      Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.

      Keywords

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      Article info

      Publication history

      Published online: January 19, 2023
      Accepted: January 17, 2023

      Identification

      DOI: https://doi.org/10.1016/j.jinf.2023.01.022

      Copyright

      © 2023 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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