336. Characteristics of Acute Bacterial Meningitis and Predictors of Mortality

BACKGROUND: Acute bacterial meningitis is a medical emergency associated with morbidity and mortality. The aim of the study was to describe clinical features, causative organisms and predictors of death among patients presented with community-acquired acute bacterial meningitis. METHODS: This retrospective study was conducted at Nakhonpathom Hospital, a 700-bed tertiary care hospital in Thailand during July 2013 and August 2017. The data on demography, clinical presentation, and outcome were collected. Factors associated with death were analysed. RESULTS: During study period, there were 55 patients. Median age was 45 (range 19 to 89) years and 38 (69%) were male. Median duration of symptom before hospitalization were 2 (range 1 to 6) days. The most common presenting symptoms were fever (98%), headache (94%), and decreased level of consciousness (75%). The classic triad of fever, headache, and neck stiffness was documented in 53%. Computed tomography scan of brain were abnormal among 57% of 35 patients. Bacteria was isolated in CSF or blood in 40 patients (73%). The most common isolates were S. agalactiae (17 cases), S. pneumoniae (4 cases) and Streptococcus group D (4 cases). All isolates of S. agalactiae and S. pneumoniae were penicillin sensitive. The in-hospital mortality was 20%. Factors associated with death were age more than 65 years (44% vs. 13%, P = 0.047), low CSF WBC (178 vs. 439 cells/mm(3), P = 0.009), and the presence of hydrocephalus on imaging (67% vs. 9%, P = 0.047). The time interval between patients’ presentation and appropriate antibiotics administration differed significantly for patients who survive and die (22 vs. 0.5 hour, P = 0.016). CONCLUSION: Acute bacterial meningitis remains associated with mortality. Age, CSF WBC, hydrocephalus, and delay antibiotics therapy were associated with outcome. DISCLOSURES: All authors: No reported disclosures.