Background: Gram-negative bacillary (GNB) meningitis is a rare cause of meningitis in adults and can occur as a spontaneous infection or as a complication of a neurosurgical procedure or trauma. We aimed to describe the characteristics and outcomes of adults with spontaneous GNB meningitis. Methods: A retrospective cohort analysis was performed of 26 patients with GNB meningitis seen at a single hospital in Soweto, South Africa. Results: A predisposing condition was found in 24 (92%) patients. The 19 (73%) HIV-infected patients had a median CD4 count of 24/mm^3. Chronic renal disease, diabetes mellitus, myeloma, and alcoholism were other underlying conditions. The HIV-infected had a median cerebrospinal fluid (CSF) neutrophil count of 2/mm^3 compared to the HIV-non-infected of 560/mm^3. Common organisms were Escherichia coli, Klebsiella pneumoniae, and non-typhoidal Salmonella in HIV-positive patients and K. pneumoniae in the HIV-negative group. Ten (38%) isolates were resistant to third-generation cephalosporins. Mortality was 65%. Conclusions: A disproportionate burden of GNB meningitis fell on the HIV-infected, among whom absent or low CSF white cells was common. Management was complicated by high rates of resistance to third-generation cephalosporins.
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机译：背景：革兰氏阴性细菌性脑膜炎是成人脑膜炎的罕见病因，可自发感染或神经外科手术或创伤的并发症发生。我们旨在描述自发性GNB脑膜炎的成人的特征和结局。方法：对在南非索韦托一家医院的26例GNB脑膜炎患者进行回顾性队列分析。结果：24名患者（92％）发现了易患病。 19名（73％）HIV感染患者的CD4计数中位数为24 / mm ^ 3。慢性肾脏疾病，糖尿病，骨髓瘤和酒精中毒是其他潜在疾病。与未感染HIV的560 / mm ^ 3相比，感染HIV的中性白细胞计数（CSF）为2 / mm ^ 3。 HIV阳性患者中常见的微生物为大肠杆菌，肺炎克雷伯菌和非伤寒沙门氏菌，HIV阴性患者中常见的微生物为肺炎克雷伯菌。十个（38％）分离株对第三代头孢菌素有抗药性。死亡率为65％。结论：感染了HIV的GNB脑膜炎负担不成比例，其中以CSF白细胞缺失或较低为常见。对第三代头孢菌素的高耐药率使管理变得复杂。
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