Meningitis Caused by Gram-Negative Bacilli

Abstract

Thirty adults with meningitis caused by gram-negative bacilli were observed from 1968 to 1978 at four hospitals associated with Boston University School of Medicine. Equal numbers of two distinct types of gram-negative bacillary meningitis—spontaneously occurring meningitis and meningitis after neurosurgery—were found. Spontaneously occurring meningitis appeared to have an abrupt onset, a relatively fulminant course, and to be caused most often by Escherichia coli and Haemophilus influenzae. Meningitis occurring after neurosurgical procedures was more insidious in onset, more protracted in course, and more often caused by organisms resistant to multiple antibiotics. Approaches to therapy are based on the differences in character of these two types of meningitis.