Journal List > Ann Clin Microbiol > v.20(4) > 1078579

Lee, Kim, Hwang, Yoo, and Uh: Trend of Bacteria and Fungi Isolated from Cerebrospinal Fluid Culture in a Tertiary Care Hospital During Recent Two Decades (1997–2016)

Abstract

Background

Meningitis is a clinically important disease because of its high mortality and morbidity. The epidemiology of this disease has changed remark-ably due to the introduction of pneumococcal vaccines and Haemophilus influenzae type b (Hib) conjugate vaccine. Therefore, it is required to continuously monitor and research the organisms isolated from cerebrospinal fluid (CSF) cultures.

Methods

We analyzed trends of bacteria and fungi isolates obtained from CSF cultures between 1997 and 2016 in a tertiary care hospital according to year, month, gender, and age.

Results

Out of a total of 38,450 samples, we identified 504 (1.3%) isolates. The isolation rate in the first tested decade (1997–2006) ranged from 1.3% to 3.1%, while that in the second decade (2007–2016) ranged from 0.4% to 1.5%. The most common organisms was coagulase-negative staphylococci (CoNS) (31.9%), followed by Staphylococcus aureus (9.5%), Streptococcus pneumoniae (7.5%), Acinetobacter baumannii (5.8%), and Mycobacterium tuberculosis (5.8%).
Monthly isolation rates were highest in May and July and lowest in February and December. Male to female ratio was 1.5:1. The isolation rates of S. pneumoniae, Enterococcus faecium, and Escherichia coli were similar in children and adults, but those of S. aureus, E. faecalis, A. baumannii, Pseudomonas aeruginosa, M. tuberculosis, and Cryptococcus neoformans were higher in adults than in children.

Conclusion

During the last two decades, the isolation rate of CSF culture per year has decreased, with monthly isolation rates being highest in May and July. CoNS, S. aureus, and S. pneumoniae were most common in males, whereas CoNS, S. pneumoniae, and M. tuberculosis were most common in females. While Group B Streptococcus was most common in infants younger than 1 year, S. aureus and C. neoformans were more common in adults.

References

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Table 1.
No. (%) of isolates from cerebrospinal fluid culture by year
Year No. of specimen cultured No. (%) of isolates
1997 2,116 36 (1.7)
1998 1,294 17 (1.3)
1999 1,295 38 (2.9)
2001 1,918 21 (1.1)
2002 2,831 38 (1.3)
2004 1,257 36 (2.9)
2005 1,349 24 (1.8)
2007 1,823 18 (1.0)
2008 3,052 21 (0.7)
2010 2,759 23 (0.8)
2011 2,559 27 (1.1)
2013 1,825 8 (0.4)
2014 1,585 19 (1.2)
2015 2,151 33 (1.5)
2016 2,681 28 (1.0)
Total 38,450 504 (1.3)
Table 2.
Distribution and isolation trend of bacteria and fungi isolates from cerebrospinal fluid culture by year
acm-20-81f1.tif
Table 2.
acm-20-81f2.tif
Table 4.
No. (%) of bacteria and fungi isolates from cerebrospinal fluid culture by gender
Organisms No. (%) of patients
Male Female Total
Gram-positive cocci      
Staphylococcus spp.      
CoNS 95 (31.4) 66 (32.8) 161 (31.9)
S. aureus 32 (10.6) 16 (8.0) 48 (9.5)
Streptococcus spp.      
S. pneumoniae 26 (8.6) 12 (6.0) 38 (7.5)
S. agalactiae 6 (2.0) 6 (3.0) 12 (2.4)
Enterococcus spp.      
E. faecium 10 (3.3) 5 (2.5) 15 (3.0)
E. faecalis Micrococcus spp.* 7 (2.3) 4 (1.3) 4 (2.0) 5 (2.5) 11 (2.2) 9 (1.8)
Gram positive bacilli      
Listeria monocytogenes 1 (0.3) 2 (1.0) 3 (0.6)
Gram negative cocci      
Haemophilus influenzae 1 (0.3) 3 (1.5) 4 (0.8)
Neisseria meningitidis 3 (1.0) 0 3 (0.6)
Gram negative bacilli      
Enterobacteriaceae      
Klebsiella pneumoniae 6 (2.0) 2 (1.0) 8 (1.6)
Escherichia coli 6 (2.0) 4 (2.0) 10 (2.0)
NFB      
Acinetobacter baumannii 18 (5.9) 11 (5.5) 29 (5.8)
Pseudomonas aeruginosa 6 (2.0) 3 (1.5) 9 (1.8)
Mycobacterium spp. Mycobacterium tuberculosis 13 (4.3) 16 (8.0) 29 (5.8)
Fungus      
Cryptococcus neoformans 8 (2.6) 4 (2.0) 12 (2.4)
Candida albicans 3 (1.0) 1 (0.5) 4 (0.8)
Others 58 (19.1) 41 (20.4) 99 (19.8)
Total 303 201 504 (100)
*,† Refer to Table 2.      

Abbreviations: CoNS, coagulase-negative staphylococci; NFB, non-fermentative gram-negative bacilli.

Table 5.
No. (%) of bacteria and fungi isolates from cerebrospinal fluid culture by age group
Organisms No. (%) of organisms isolates by age group (year)
<1 1–19 20–69 ≥70 Total
Gram-positive cocci          
Staphylococcus spp.          
CoNS 22 (28.9) 28 (28.9) 93 (33.3) 18 (34.6) 161 (31.9)
S. aureus* 2 (2.6) 9 (9.3) 31 (11.1) 6 (11.5) 48 (9.5)
Streptococcus spp.          
S. pneumoniae 3 (3.9) 15 (15.5) 16 (5.7) 4 (7.7) 38 (7.5)
S. agalactiae 10 (13.2) 0 1 (0.4) 1 (1.9) 12 (2.4)
Enterococcus spp.          
E. faecium 4 (5.3) 3 (3.1) 8 (2.9) 0 15 (3.0)
E. faecalis 2 (2.6) 1 (1.0) 8 (2.9) 0 11 (2.2)
Micrococcus spp. 1 (1.3) 2 (2.1) 6 (2.2) 0 9 (1.8)
Gram-positive bacilli          
Listeria monocytogenes 0 0 3 (1.1) 0 3 (0.6)
Gram-negative cocci          
Haemophilus influenzae 1 (1.3) 3 (3.1) 0 0 4 (0.8)
Neisseria meningitidis 0 2 1 (0.4) 0 3 (0.6)
Gram-negative bacilli          
Enterobacteriaceae          
Klebsiella pneumoniae 2 (2.6) 1 (1.0) 5 (1.8) 0 8 (1.6)
Escherichia coli 3 (3.9) 2 (2.1) 4 (1.4) 1 (1.9) 10 (2.0)
NFB          
Acinetobacter baumannii 4 (5.3) 2 (2.1) 21 (7.5) 2 (3.8) 29 (5.8)
Pseudomonas aeruginosa 2 (2.6) 0 5 (1.8) 2 (3.8) 9 (1.8)
Mycobacterium spp.          
M. tuberculosis 2 (2.6) 4 (4.1) 18 (6.5) 5 (9.6) 29 (5.8)
Fungus          
Cryptococcus neoformans* 0 0 9 (3.2) 3 (5.8) 12 (2.4)
Candida albicans 2 (2.6) 0 2 (0.7) 0 4 (0.8)
Others§ 16 (19.7) 25 (19.6) 48 (17.2) 10 (19.2) 99 (19.8)
Total 76 97 279 52 504 (100)

*P-value<0.05;

P-value<0.01.

‡,§ Refer to Table 2. Abbreviations: CoNS, coagulase-negative staphylococci; NFB, non-fermentative gram-negative bacilli.

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