Bacterial and fungal meningitis in adults: a 22-year survey in a large community hospital in Israel.

The etiologic, bacteriological, clinical and therapeutic aspects of 95 cases of bacterial or fungal meningitis in adults seen in a large community hospital were reviewed. The study was limited to non-neurosurgical patients in whom positive cerebrospinal fluid cultures were obtained. Overall mortality was 40%, with no appreciable change during the 22-year period. The most common causative organism was the pneumococcus, with a 45% mortality. There were no deaths among the patients with meningococcal meningitis. Cryptococcus neoformans was the third most common single organism encountered. Meningitis due to uncommon organisms usually developed in debilitated or immunologically compromised patients, and had a poor prognosis. Advanced age, underlying debilitating disease and severly impaired consciousness on admission were associated with a high mortality. Bacterial and fungal meningitis in adults remains a serious life-threatening disease, despite advances in antibiotic therapy.