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Gram-negative bacillary meningitis: Epidemiology, clinical features, and diagnosis

N Deborah Friedman, MPH, MBBS, FRACP, MD
Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Most cases of gram-negative bacillary meningitis occur in neonates or infants [1]. Gram-negative bacilli are the fifth most common cause of meningitis in infants, accounting for 3.6 percent of cases [2]. By contrast, gram-negative bacilli are an uncommon etiology of community-acquired meningitis in adults, but are a common cause of nosocomial meningitis, often occurring as a complication of head trauma and craniotomy [3].

The epidemiology, clinical features, and diagnosis of gram-negative bacillary meningitis will be reviewed here. Issues related to treatment are discussed separately. (See "Gram-negative bacillary meningitis: Treatment".)


Gram-negative meningitis was first recognized and reported in 1892. In the 1930s and 40s, cases were described resulting from abortion, genitourinary manipulation, and spinal anesthesia. In the following two decades, gram-negative bacillary meningitis was recognized as an occasional complication of injuries and neurosurgical procedures [4].

Subsequently, gram-negative bacillary meningitis has become an important cause of hospital-associated central nervous system (CNS) infection in adults, usually due to neurosurgery [5]. The likelihood of post-neurosurgery meningitis being due to gram-negative organisms is increased when antimicrobial prophylaxis, which predominantly provides gram-positive coverage, is given to prevent surgical site infection [6]. (See "Epidemiology of bacterial meningitis in adults", section on 'Healthcare-associated meningitis' and "Antimicrobial prophylaxis for prevention of surgical site infection in adults", section on 'Neurosurgery'.)

Although the incidence of gram-negative bacillary meningitis has increased as progressively more complex neurosurgical techniques and operations become more commonplace, this is still a rare infection. As an example, meningitis caused by Enterobacteriaceae accounted for 1.5 percent of all cases of acute bacterial meningitis in adults over a 20 year period in one Danish hospital [7]. In addition, of 1961 isolates of gram-negative bacilli from blood and/or cerebrospinal fluid (CSF) specimens over a two-year period at our institution, only 47 (2.4 percent) were from the CSF (unpublished data).

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Literature review current through: Nov 2017. | This topic last updated: Oct 09, 2017.
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