CNS INFECTIONS: Edited by Adarsh BhimrajUpdate and advances in community acquired bacterial meningitisHasbun, RodrigoAuthor Information Section of Infectious Diseases, UT Health McGovern Medical School, Houston, Texas, USA Correspondence to Rodrigo Hasbun, MD, MPH, Professor of Medicine, Section of Infectious Diseases, UT Health McGovern Medical School, 6431 Fannin St., 2.112 MSB, Houston, TX 77030, USA. Tel: +1 713 500 7140; fax: +1 713 500 5495; e-mail: [email protected] Current Opinion in Infectious Diseases: June 2019 - Volume 32 - Issue 3 - p 233-238 doi: 10.1097/QCO.0000000000000543 Buy Metrics Abstract Purpose of review Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens. Recent findings Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic therapy impacts the yield of microbiological results. Delaying antibiotic therapy is associated with worse clinical outcomes. Adjunctive steroids have reduced the mortality of adults with pneumococcal meningitis but have been associated with increased adverse outcomes in Listeria monocytogenes and Cryptococcus neoformans. Summary Community-acquired bacterial meningitis remains a global health concern with high morbidity and mortality especially in low-income countries. Cranial imaging should be done only in patients with an indication with an attempt to do a prompt lumbar puncture and to initiate antibiotic therapy and adjunctive steroids as soon as possible to improve clinical outcomes. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.