Methods: This retrospective study was conducted at Nakhonpathom Hospital, a 700-bed tertiary care hospital in Thailand during July 2013 and August 2017. The data on demography, clinical presentation and outcome were collected. Factors associated with death were analysed.
Results: During study period, there were 55 patients. Median age was 45 (range 19 to 89) years and 38 (69%) were male. Median duration of symptom before hospitalization were 2 (range 1 to 6) days. The most common presenting symptoms were fever (98%), headache (94%) and decreased level of consciousness (75%). The classic triad of fever, headache and neck stiffness was documented in 53%. Computed tomography scan of brain were abnormal among 57% of 35 patients. Bacteria was isolated in CSF or blood in 40 patients (73%). The most common isolates were S.agalactiae (17 cases), S.pneumoniae (4 cases) and Streptococcus group D (4 cases). All isolates of S.agalactiae and S.pneumoniae were penicillin sensitive. The in-hospital mortality was 20%. Factors associated with death were age more than 65 years (44% vs 13%, p 0.047), low CSF WBC (178 vs 439 cells/mm3, p 0.009) and the presence of hydrocephalus on imaging (67% vs 9%, p 0.047). The time interval between patients’presentation and appropriate antibiotics administration differed significantly for patients who survive and die (22 vs 0.5 hour, p 0.016).
Conclusion: Acute bacterial meningitis remains associated with mortality. Age, CSF WBC, hydrocephalus and delay antibiotics therapy were associated with outcome.