Adherence to Standard of Care in the Diagnosis and Treatment of Suspected Bacterial Meningitis. (November 2015)

• Record Type: Journal Article
• Authors: Chia, David; Yavari, Youness; Kirsanov, Eugeny; Aronin, Steven I.; Sadigh, Majid
• Is Part Of: American journal of medical quality. Volume 30:Number 6(2015:Nov./Dec.)
• Page Start: 539
• Page End: 542
• Publication Date: 2015-11
• Subjects: bacterial meningitis -- guidelines -- adherence -- standard of care; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860614545778
• Languages: English
• ISSNs: 1062-8606

Abstract

Acute bacterial meningitis (ABM) is a rare but deadly neurological emergency. Accordingly, Infectious Diseases Society of America (IDSA) guidelines summarize current evidence into a straightforward algorithm for its management. The goal of this study is to evaluate the overall compliance with these guidelines in patients with suspected ABM. A retrospective cross-sectional study was conducted of adult patients who underwent lumbar puncture for suspected ABM to ascertain local adherence patterns to IDSA guidelines for bacterial meningitis. Primary outcomes included appropriate utilization of neuroimaging, blood cultures, antibiotics, corticosteroids, and lumbar puncture. In all, 160 patients were included in the study. Overall IDSA compliance was only 0.6%. Neuroimaging and blood cultures were appropriately utilized in 54.3% and 47.5% of patients, respectively. Steroids and antibiotics were appropriately administered in only 7.5% and 5.6% of patients, respectively. Adherence to IDSA guidelines is poor. Antibiotic choice is often incorrect, corticosteroids are rarely administered, and there is an overutilization of neuroimaging.