Adults with meningitis caused by oxacillin-resistant Staphylococcus aureus

Abstract

Since 1995, 11 adult patients with oxacillin-resistant Staphylococcus aureus (ORSA) meningitis have been identified at Chang Gung Memorial Hospital-Kaohsiung, in Kaohsiung, Taiwan. The 11 patients were 8 men and 3 women, aged 17-78 years. A postneurosurgical state was an underlying condition for all, and fever and disturbances in consciousness were the most common clinical manifestations. Infection with S. aureus only was found in 8 patients, and mixed infection was found in the other 3. The 8 patients with meningitis caused by S. aureus only were mainly treated with intravenous vancomycin, 2-4 g/day; 4 of these patients died. Although ORSA meningitis is uncommon among adults with culture-proven bacterial meningitis, its incidence has been increasing in recent years. The diagnosis of adult ORSA meningitis can be confirmed only with a positive culture of cerebrospinal fluid, and the choice of initial empirical antibiotics must be guided by the accumulated data concerning the relative frequency of the implicated pathogens found at each institution. Despite the high rate of mortality associated with ORSA meningitis, intravenous vancomycin therapy seems to be one of the best choices for management of this condition in adults.