Background: Acute bacterial meningitis [ABM] is a medical emergency associated with high morbidity and mortality.

Objective: To describe the clinical features, causative organisms, and predictors of death among patients presented with communityacquired ABM.

Materials and Methods: The present retrospective study was conducted at Nakhon Pathom Hospital, a 722-bed tertiary care hospital in Thailand between July 2013 and August 2017. The data on demography, clinical presentation, and outcome were collected. Factors associated with death were analyzed.

Results: During the 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 two days (range 1 to 6). 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 was 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% versus 13%, p = 0.047), low cerebrospinal fluid [CSF] white blood cell [WBC] (178 versus 439 cells/mm³, p = 0.009), and the presence of hydrocephalus on imaging (67% versus 9%, p = 0.045). The time interval between patients’ presentation and appropriate antibiotics administration differed significantly for patients who survived and died (22 versus 0.5 hour, p = 0.016).

Conclusion: ABM remains associated with high mortality. Age, CSF WBC, hydrocephalus, and delay antibiotics therapy were associated with outcome.

Keywords: Acute bacterial meningitis, Predictors of dead, Epidemiology