Adult bacterial meningitis in Taiwan

The causative pathogens of adult bacterial meningitis may vary with different time period, geographic distribution, age, race, underlying medical and/or neurosurgical conditions, status of vaccination and means of contraction. The relative frequency of causative pathogens may influence the choice of initial empirical antibiotics in the management of adult bacterial meningitis. In Taiwan, Klebsiella (K.) species, especially the K. pneumoniae, are the most commonly implicated Gram-negative bacilli. There is a high incidence of diabetes mellitus among the patients with K. pneumoniae meningitis. The co-existance of extracranial and/or intracranial focal suppuration is a characteristic finding of this specific infection. Of the Gram-positive micro-organisms found in adult bacterial meningitis, Streptococcus (S.) pneumoniae remains the most common in community-acquired infection, while Staphylococcus (S.) aureus infection is common among the patients with post-neurosurgical state and most of them belong to oxacillin-resistant strains. In the choice of initial empirical antibiotics in the management of adult bacterial meningitis, these specific microbiologic characteristics found in Taiwan should be taken into consideration in order to bring a successful therapeutic result.