Microbiology and long-term outcomes in community-acquired, nosocomial and post-neurosurgical meningitis with positive bacterial culture in Ontario, Canada: A population-based cohort study
Bibliographic record
Abstract
BACKGROUND: Bacterial meningitis is a rare but severe infection that has a high risk of mortality and morbidity. The study objective was to describe the microbiology, long-term mortality risk, and complications from neurologic sequelae for bacterial meningitis. METHODS: This retrospective cohort study included adults with a positive cerebrospinal fluid (CSF) bacterial culture collected from 2014 to 2022 inclusive in Ontario, Canada. Patients were followed for 1 year. The primary outcome was all-cause mortality. Secondary outcomes included aspiration, enteral feeding tube insertion, decubitus ulcers, falls and/or fractures, and long-term care admissions. RESULTS: 856(2.1%) patients had positive CSF cultures including 431(50.4%) community-acquired, 255 (29.8%) nosocomial and 170(19.9%) post-neurosurgical meningitis cases. Staphylococcus aureus was the second most common pathogen in community-acquired meningitis (10.9%) and the most common pathogen in nosocomial (11.8%) and post-neurosurgical (22.9%) meningitis. All-cause mortality at 30, 90, 180, and 365 days were 11.4%, 13.2%, 14.8% and 16.5% for community-acquired meningitis; 16.5%, 22.4%, 25.1% and 27.1% for nosocomial meningitis; and 10.6%, 20.0%, 25.9% and 28.8% for postneurosurgical meningitis. Enteral feeding tube was inserted in 2.8%, 15.3%, and 20.0% of community-acquired, nosocomial, and post-neurosurgical meningitis cases respectively. Other secondary outcomes occurred rarely. CONCLUSION: S. aureus was an important pathogen. Meningitis mortality continued to increase over 1 year. For nosocomial and post-neurosurgical meningitis, one in four died by 1 year and many required enteral feeding tube.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".