Adult bacterial meningitis - A quality registry study: Earlier treatment and favourable outcome if initial management by infectious diseases physicians.
Clin Microbiol Infect. 2015 Mar 6;
Authors: Grindborg Ö, Naucler P, Sjölin J, Glimåker M
Abstract
BACKGROUND: Acute bacterial meningitis (ABM) is challenging for the admitting physician because it is a rare but fulminant disease, usually presenting without typical symptoms, and where rapid treatment is pivotal. The purpose of this study was to evaluate the effect of initial management by infectious diseases (ID) physicians versus non-ID physicians.
METHODS: Five-hundred-twenty consecutive adults (>17 years old), 110 with initial ID-management and 410 with non-ID-management, registered in the Swedish quality registry for community-acquired ABM January 2008 to December 2013 were analysed retrospectively. Primary outcome was appropriate treatment with antibiotics and corticosteroids <1 h from admission. Secondary analyses were mortality during hospital stay, and persisting neurological and hearing deficits at follow-up after 2-6 months. Differences in diagnostic treatment sequences were also analysed.
RESULTS: Appropriate treatment <1 h from admission was achieved significantly more often (41%) by ID physicians versus non-ID physicians (24%) with an odds ratio (OR) of 2.4 (95% CI: 1.40-4.14; p<0.01) adjusted for confounders. The door-to-antibiotic time was significantly shorter and significantly more patients were administered corticosteroids together with the first doses of antibiotics in the ID group. A trend of decreased mortality (4.5% versus 8.0%) and sequelae at follow-up (24% versus 44%; adjusted OR 0.55: 95% CI 0.31-1.00; p=0.05) were observed in the ID-group versus the non-ID group. Antibiotics were started without prior neuro-imaging more often in the ID-group (86% versus 57%; p<0.001).
CONCLUSIONS: Initial management at the emergency department by ID physicians is associated with earlier appropriate treatment, more appropriate diagnostic-treatment sequences and favourable outcome.
PMID: 25752223 [PubMed - as supplied by publisher]