Community-acquired spontaneous bacterial meningitis in patients with alcoholic liver disease

Background and Purpose: Data on the clinical characteristics of adult alcoholic liver disease (ALD) patients with acute bacterial meningitis is limited. This study analyzed the clinical and laboratory data and therapeutic outcome of 14 men with ALD treated over a 15-year period. Methods: Standardized forms were used to collect data from medical records of all adult patients with bacterial meningitis admitted to Chang Gung Memorial Hospital-Kaohsiung from January 1986 to December 2000. Data collected included microbiological records for cerebrospinal fluid, blood cultures, and all medical records. Results: Three of the 14 patients with ALD had liver cirrhosis (2 with Child's class B and 1 with Child's class C). The causative pathogens of these 14 cases were Klebsiella pneumoniae in 11, Staphylococcus aureus in 2 and Enterococcus in 1. Diabetes mellitus (DM) was the most common underlying disease and was present in 64% of patients (9/14). All patients with DM had K. pneumoniae as the causative pathogen. Bacteremia and thrombocytopenia were found in 64% (9/14) and 50% (7/14) of the patients, respectively. Focal suppurations including brain abscess, intracranial subdural empyema, and cervical epidural abscess were found in 4 patients. The overall mortality rate was 14% (2/14). ALD accounted for 11.5% (14/122) of the underlying conditions of all adult cases of community-acquired spontaneous bacterial meningitis treated during the study period. Conclusions: There was a high incidence of K. pneumoniae infection in adult meningitis patients with ALD, especially those with concomitant DM.