Although bacterial meningitis is known to be among the top infectious causes of death, there has not been a robust longitudinal study of the associated morbidity, mortality, or economic burden in recent years.

This study examines the healthcare resource utilization (HCRU) in the United States (US) of community-acquired versus nosocomial bacterial meningitis infections and characterizes the relative prevalence of these infections, incidence of ensuing complications, and associated rates of mortality.

The Truven Health MarketScan® Research database was used to identify patients with a bacterial meningitis diagnosis admitted to a hospital in the US between 2008 and 2015. HCRU data was collected for up to 2 years following initial diagnosis. Cost analyses were conducted for patients without head trauma.

5181 patients diagnosed with bacterial meningitis were identified. Of these, 88.0% were adults and 12.0% were pediatric patients (<=18yo). Nosocomial infections comprised 24.8% of bacterial meningitis cases  (main organisms: staphylococcus/MRSA, gram negative, and anaerobic bacteria). Community-acquired infections accounted for 23.5% of cases (main organisms: streptococcus, pneumococcus, and meningococcus). The remainder (51.7%) were other bacterial types (e.g. haemophilus) or were unspecified. Median length of stay for the index admission was 10.0 days (IQR, 5.0 to 19.0 days). The 30-day complication rate for nosocomial infections and community-acquired infections was 38.8% and 27.3%, respectively. The most common complications were hydrocephalus (8.3%), intracranial epidural abscess (7.1%) and intracerebral hemorrhage (6.9%). The 30-day hospital inpatient mortality rate was 4.1% for nosocomial infections and 6.6% for community-acquired infections (p=0.0056). Median 90-day cost for the nosocomial group was $84895.3 (IQR, $38903.1 to $174241.9) versus $51977.80 (IQR, $29290.1 to $107786.4) for the community-acquired group.

Our study characterizes a longitudinal cohort of 5181 bacterial meningitis cases in the US from 2008-2015. The health economic impact, morbidity, and mortality were quantified, demonstrating the substantial HCRU of bacterial meningitis patients in the US.