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Biomed J. 2013 Nov-Dec;36(6):295-303. doi: 10.4103/2319-4170.113368.

Mixed infection in adult post-neurosurgical bacterial meningitis: a hospital-based study.

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Department of Family Medicine and Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.



Post-neurosurgical (post-NS) adult bacterial meningitis (ABM) with mixed infection is rarely examined solely in the literature.


The clinical features and laboratory data of post-NS ABM patients with mixed infection were included for analysis.


Totally 170 post-NS ABM cases were identified and 18 (11 men and 7 women, aged 20-77 years, median = 57.5) of them had a mixed infection. A total of 45 bacterial strains including 34 Gram-negative [Gm(-)] strains and 11 Gram-positive [Gm(+)] strains were isolated. Of the implicated pathogens, Escherichia coli, Acinetobacter, Pseudomonas, and Klebsiella spp. were the common Gm(-) strains, while staphylococcal, streptococcal, and enterococcal strains were the common Gm(+) strains. Compared with the post-NS ABM cases with monomicrobial infection, those with mixed infection had a lower cerebrospinal fluid (CSF) white blood cell count. The mortality rate of post-NS ABM cases was 33.3% (6/18) without significant clinical and laboratory difference between the fatal and non-fatal groups.


Mixed infection is not uncommon in post-NS ABM (10.6%, 18/170), and its mortality rate is high. Seventy-six percent of the implicated bacterial pathogens belonged to Gm(-) strains, while the other 24% were Gm(+) strains. The clinical and laboratory features of ABM with mixed infection are not unique; its diagnosis can only be confirmed by a positive CSF culture.

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