An audit of acute bacterial meningitis in a large teaching hospital 2005–10
Abstract
BACKGROUND: Acute bacterial meningitis (ABM) is a rare disease associated with severe neurological sequelae and death. Clinical features on admission may be subtle and thus delay recognition. Previous studies have shown association between early administration of antibiotics and favourable outcomes. AIM: To examine the presenting clinical features of patients aged >15 years with ABM admitted to a University teaching hospital. To audit investigations and treatment including lumbar puncture (LP), computed tomography (CT) and antibiotics against British Infection Association guidelines. DESIGN: Retrospective observational audit. METHODS: Hospital records were reviewed for presenting clinical features and timing of CT scan, LP and antibiotics. RESULTS: Records of 39 patients with ABM were reviewed. The classical triad of fever, neck stiffness and altered mental state was present on admission in only 21% of cases. LP was contraindicated in 69% of cases. Immediate LP was carried out in only 17% of those who had no contraindication. Antibiotics were administered after a median of 79 min (interquartile range 24-213 min); 65% were given within 3 h after arrival. Eighty-five percent of patients had antibiotics in accordance with local guidelines. CONCLUSION: In patients with ABM, the classical clinical features are uncommon on arrival to hospital and frequently evolve following admission. The majority of patients have contraindications to immediate LP. Efforts should be made to facilitate immediate LP performed in the Emergency Department when there are no contraindications. Earlier administration of antibiotics in cases of suspected ABM and close review following admission is recommended.
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Suboptimal use of molecular diagnostics and HIV-testing has been highlighted as areas for improvement.
“Suboptimal use of molecular diagnostics and HIV-testing has also been highlighted as areas for improvement.39,[59][60][61]”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [59]
The Microbiology section reports that blood PCR was used in only 11 of 39 patients (28%), and the Discussion highlights PCR’s utility in diagnosing culture-negative meningitis. This supports concern about limited use of molecular diagnostics, but our copy does not address HIV testing as an area for improvement (searched: HIV, HIV testing). (LLM, conf=0.85)
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- Authors
- Stockdale, A. J., Weekes, M. P., & Aliyu, S. H.
- Affiliations
- Cambridge University Hospitals NHS Foundation Trust (GB)
- Venue
- QJM
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-08-11
- Volume
- 104
- Issue
- 12
- Pages
- 1055-1063
- ISSN
- 0033-5622 (ISSN-L)
- 1460-2725
- 1460-2393
- OpenAlex
- W2138462342
- Cited by
- 24
- References
- 21
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 2 · 2021: 2 · 2019: 2 · 2018: 3 · 2016: 5 · 2015: 2 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- QJM (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- acute bacterial meningitis, lumbar puncture, timing of antibiotic administration, computed tomography, clinical guidelines adherence, emergency department, delayed diagnosis, young adults
- MeSH terms
- Acute Disease, Adult, Aged, Anti-Bacterial Agents, Emergency Service, Hospital, England, Female, Hospitals, Teaching, Humans, Male, Medical Audit, Middle Aged, Retrospective Studies, Spinal Puncture, Time Factors, Tomography, X-Ray Computed, Meningitis, Bacterial, Practice Guidelines as Topic, Guideline Adherence, Young Adult
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