ABSTRACT Aim: The purpose of this study was to detect prognostic factors of acute bacterial meningitis on admission. Methods: Analysis of clinical and laboratory data of 60 adult acute bacterial meningitis patients admitted at Alexandria fever hospital between July 2014 to February 2015 including: age, sex, vital signs, conscious level, CSF findings, routine lab tests, metabolic acidosis, and causative organism was done initially on admission and then correlated with the patients' outcome on discharge which was either complete recovery (68.3%), recovery with sequelae (13.3%), or death (18.3%). Results: Factors associated with poor outcome were: Old age (P= 0.019), hypotension (p=0.003), low GCS (P=0.001), uremia (p=0.041), metabolic acidosis (P= 0.016), history of chronic hypertension (P= 0.018), Delayed referral &long duration of symptoms (P= 0.024). Conclusion: Acute bacterial meningitis patients having any of those poor prognostic criteria should be considered high risk patients and should have the priority for ICU admission and intensive monitoring. Key words: Acute bacterial meningitis, prognostic factors. REFERENCES Aronin SI, Peduzzi P, Quagliarello VJ. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998;129(11):862-9. Auburtin M, Porcher R, Bruneel F, Scanvic A, Trouillet JL, Bedos JP, et al. Pneumococcal meningitis in the intensive care unit: prognostic factors of clinical outcome in a series of 80 cases. Am J Respir Crit Care Med 2002; 165(5):713-7. Bohr V, Rasmussen N, Hansen B, Gade A, Kjersem H, Johnsen N, et al. Pneumococcal meningitis: an evaluation of prognostic factors in 164 cases based on mortality and on a study of lasting sequelae. J Infect 1985; 10(2):143-57. Flores-Cordero JM, Amaya-Villar R, Rincon-Ferrari MD, Leal-Noval SR, Garnacho-Montero J, Llanos-Rodriguez AC, et al. Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors. Intensive Care Med 2003; 29(11):1967-73. Hoen B, Viel JF, Gerard A, Dureux JB, Canton P. Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors. Eur J Med 1993;2(1):28-32. Ispahani P. Bacterial meningitis in Nottingham. J Hygiene 1983;91(02):189-201. Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain 2003;126(Pt 5):1015-25. Kowalik MM, Smiatacz T, Hlebowicz M, Pajuro R, Trocha H. Coagulation, coma, and outcome in bacterial meningitis--an observational study of 38 adult cases. J Infect 2007;55(2):141-8. Lu CH, Huang CR, Chang WN, Chang CJ, Cheng BC, Lee PY, et al. Community acquired bacterial meningitis in adults:the epidemiology, timing of appropriate antimicrobial therapy,and prognostic factors. ClinNeurolNeurosurg 2002;104(4):352-8. Singh UK, Sinha RK, Suman S, Singh VK.C-reactive protein as an indicator of complications in bacterial meningitis. Indian Pediatr 1996;33(5):373-6. Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351(18):1849-59. Van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006;354(1):44-53. Vibha D, Bhatia R, Prasad K, Srivastava MV, Tripathi M, Singh MB. Clinical features and independent prognostic factors for acute bacterial meningitis in adults. Neurocrit Care 2010;13(2):199-204. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J. A risk score for unfavorable outcome in adults with bacterial meningitis. Ann Neurol 2008;63(1):90-7. Zaky S, Baki AA, Farouk S, Sabry S, Deraz AS, Sanad M, et al. Presentation, prognostic factors and outcome of acute septic meningitis in an Egyptian fever hospital. Ind J Sci Res Tech 2014;2(5):112-8.