Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR). Issue 7 (13th July 2022)

• Record Type: Journal Article
• Authors: Ellis, Jayne; Harvey, David; Defres, Sylviane; Chandna, Arjun; MacLachlan, Eloisa; Solomon, Tom; Heyderman, Robert S; McGill, Fiona
• Other Names: author non-byline.; Chue Amy author non-byline.; Moran Ed author non-byline.; Gokani Karishma author non-byline.; Thompson Joseph author non-byline.; Ajdukiewicz Katherine author non-byline.; Ward Victoria author non-byline.; Barrett Lucinda author non-byline.; Edwards Frances author non-byline.; Usher Adam author non-byline.; McLeod Mairi author non-byline.; Singh Ramandeep author non-byline.; Htwe Su su author non-byline.; Rogers Benedict author non-byline.; Duane Grace author non-byline.; Wiselka Martin author non-byline.; Wong Nicholas author non-byline.; Vink Elen author non-byline.; Poyner Jennifer author non-byline.; Crane Jenni author non-byline.; Lloyd Ollie author non-byline.; Chisholm Emma author non-byline.; Kustos Ildiko author non-byline.; McEwen Ruth author non-byline.; Sutton Sam author non-byline.; Jones Lewis author non-byline.; Tilley Robert author non-byline.; Estee Torok M. author non-byline.; Ramsay Isobel author non-byline.; Ivan Monica author non-byline.; York Joshua author non-byline.; Ansett Jennifer author non-byline.; Varadarajan Maithili author non-byline.; Eshiwe Celestine author non-byline.; Fife Amanda author non-byline.; Harris Stephanie author non-byline.; Jayesinghe Ryan author non-byline.; Sekhon Priya author non-byline.; Cruise James author non-byline.; Larkin Susan author non-byline.; Kanabar Shivani author non-byline.; Mutengesa Ernest author non-byline.; Ling Mirella author non-byline.; Green Christopher author non-byline.; Williams Martin author non-byline.; Stevens Matthew author non-byline.; Griffith David author non-byline.; Bulteel Naomi author non-byline.; Milne Charlotte author non-byline.; Sarma Jayanta author non-byline.; Wilson Aline author non-byline.; Shone John author non-byline.; Urquhart Lynn author non-byline.; Eldirdiri Sahar author non-byline.; Muir Alison author non-byline.; White Leila author non-byline.; Aberdein Jody author non-byline.; Simpson Phillip author non-byline.; Mar Hnin Hay author non-byline.; Bowen John author non-byline.; Tan Keying author non-byline.; Zin thein Eint Shwe author non-byline.; Aziz Mahmoud author non-byline.; Cadwgan Anthony author non-byline.; Davies Brendan author non-byline.; White Daniel author non-byline.; Weston Natasha author non-byline.; Zeb Salman author non-byline.; Houston Angela author non-byline.; Fordham Imogen author non-byline.; Evans Terry John author non-byline.; Wootton Louise author non-byline.; Turner David author non-byline.; Willingham Iona author non-byline.; Johnson Aimee author non-byline.; Wickramasinghe Nimal author non-byline.; Horsley Ashley author non-byline.; Trainor Eamonn author non-byline.; Gaillemin Olivier author non-byline.; Rosser Andrew author non-byline.; Norton Nicholas J author non-byline.; Crossingham Iain author non-byline.; Cheung Katie author non-byline.; Duxbury Megan author non-byline.; Deshpande Ashutosh author non-byline.; Bellhouse Emilie author non-byline.; Khalsa Kamaljit author non-byline.; Brezovjakova Helena author non-byline.; McLean Emma author non-byline.; Tanmay Kanitkar author non-byline.; Davies Nicholas author non-byline.; Dawidziuk Alexsander author non-byline.; Allen Joanna author non-byline.; Saman Razan author non-byline.; Kelly Sarah author non-byline.; Adler Hugh author non-byline.; Ejere Elshadai author non-byline.; Shah Aarti author non-byline.; Soo Yiwen author non-byline.; Beadles Wendy author non-byline.; Sturgeon Heather author non-byline.; Cameron Brodie author non-byline.; Ben Tomlinson David Chadwick author non-byline.; McGoldrick Claire author non-byline.; McDowell Katie author non-byline.; Miller Alastair author non-byline.; Graham Clive author non-byline.; Molosiwa Mpho author non-byline.; Hunter Ewan author non-byline.; Owen Ruth author non-byline.; Kennedy Katherine FlackAdrian author non-byline.; Robinson Amy author non-byline.; Cross Phoebe author non-byline.; Perry Fay author non-byline.; Inpadhas Vithusha author non-byline.; Khan Ali author non-byline.; Selvam Sarathy author non-byline.; Bateman Vhairi author non-byline.; Wong Jeremy author non-byline.; Wu Henry author non-byline.; Pasztor Monika author non-byline.; Patel Trupti author non-byline.; Karunakaran Ajanthiha author non-byline.; Soliman Basma author non-byline.; Paraiso Hassan author non-byline.; McLeod Mairi author non-byline.; Htwe Su su author non-byline.; Smith Anna author non-byline.; Blanshard Andrew author non-byline.; Reddy Harish author non-byline.; Shahi Avneet author non-byline.; Chesterfield Helen author non-byline.; Schroeder Ben author non-byline.; Woodhouse Ken author non-byline.; Coebergh Jan author non-byline.; Levee Viva author non-byline.; Muldoon Eavan author non-byline.; O'regan Rhea author non-byline.; Teoh Tee Keat author non-byline.; Subbarao Sathyavani author non-byline.; Tiberi Simon author non-byline.; Bell Caryn RosmarinLucy author non-byline.; Lambourne Jonathan author non-byline.; McGuire Emma author non-byline.; Serafino Robert author non-byline.; Goodman Anna author non-byline.; Bhide Ishaan author non-byline.; Sagoo Karanjeet author non-byline.; Melzer Mark author non-byline.; Krutikov Maria author non-byline.; Balakrishnan Indran author non-byline.; Hopkins Susan author non-byline.; Jones Tim author non-byline.; Patel Kajal author non-byline.; Faris Barzo author non-byline.; Calver Graeme author non-byline.; Singh Ricky author non-byline.; Sanghvi Hazel author non-byline.; Eltayeb Mohamed author non-byline.; Haris Rathur author non-byline.;
• Is Part Of: BMJ open. Volume 12:Issue 7(2022)
• Publication Date: 2022-07-13
• Subjects: Diagnostic microbiology -- Molecular diagnostics -- Infectious disease/HIV -- INTERNAL MEDICINE -- Protocols & guidelines -- BACTERIOLOGY; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2022-062698
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland. Design: Retrospective cohort study. Setting: 64 UK and Irish hospitals. Participants: 1471 adults with community-acquired meningitis of any aetiology in 2017. Results: None of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti- Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10). Conclusion: This study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.