Meningitis is a public health concern. It is caused by several etiologic agents that vary by age group and geographical area. This study aims to highlight the etiological and predictive factors of acute meningitis in hospitalized febrile patients in Mansoura Fever Hospital, Egypt. This study includes cases admitted with suspected meningitis. The study is conducted in the period between April 2019 and March 2020. Lumbar puncture, CSF examination and blood culture and sensitivity were done. Brain Magnetic Resonance Imaging (MRI) was performed before lumbar puncture in some patients. Detailed analysis of epidemiologic characteristics, clinical data, laboratory findings, the causative organisms and predictors of patients with Bacterial Meningitis (BM) were studied. This study included 110 patients had BM with CSF leukocytosis > 100 cells/mm3. Out of 110 CSF samples, 95 cases (86.4%) pathogens were detected by direct Gram-stained smear. Gram positive cocci were the commonest microorganism isolated. 66.4% of patients had blood culture growth of the same organism as the CSF culture. Reagent strip CSF examinations showed a positive correlation compared with laboratory tests. BM had 22.7% mortality rate. Predictive factors of poor outcomes include CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis. Prognostic factors that are associated with poor outcome include old age, late presentation, delayed antibiotics treatment, neurologic complications and Glasgo Coma Scale (GCS). BM remains a leading cause of morbidity and mortality,so early diagnosis and treatment decrease both. Predictors of poor outcome of BM are CSF/serum glucose ratio >0.6, CSF protein >80 mg/dl and Tonsillitis.