학술논문
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)
Document Type
article
Author
Amy Robinson; Kamaljit Khalsa; Arjun Chandna; John Bowen; Viva Levee; Jan Coebergh; Tom Solomon; Clive Graham; David Turner; Robert Tilley; Tim Jones; Susan Hopkins; Matthew Stevens; Daniel White; Celestine Eshiwe; Anna Goodman; Ramandeep Singh; Robert S Heyderman; Nicholas Davies; Joseph Thompson; Ed Moran; Sarah Kelly; Martin Williams; Rhea O’Regan; Simon Tiberi; Jonathan Lambourne; Naomi Bulteel; Susan Larkin; Ruth McEwen; Hassan Paraiso; Aarti Shah; Martin Wiselka; Sylviane Defres; Ernest Mutengesa; Maria Krutikov; Ruth Owen; David Griffith; David Harvey; Trupti Patel; Brendan Davies; Emma Mclean; Joanna Allen; Ali Khan; Alastair Miller; Ashutosh Deshpande; Christopher Green; Lewis Jones; Mark Melzer; Fiona McGill; Amanda Fife; Nimal Wickramasinghe; Stephanie Harris; Ewan Hunter; Jayne Ellis; Benedict Rogers; Imogen Fordham; Elen Vink; Victoria Ward; Anna Smith; Andrew Rosser; Alison Muir; Ken Woodhouse; John Shone; Iain Crossingham; Ryan Jayesinghe; Eavan Muldoon; Avneet Shahi; Terry John Evans; Jeremy Wong; Eloisa MacLachlan; Amy Chue; Karishma Gokani; Katherine Ajdukiewicz; Lucinda Barrett; Frances Edwards; Adam Usher; Mairi McLeod; Su su Htwe; Grace Duane; Nicholas Wong; Jennifer Poyner; Jenni Crane; Ollie Lloyd; Emma Chisholm; Ildiko Kustos; Sam Sutton; M. Estee Torok; Isobel Ramsay; Monica Ivan; Joshua York; Jennifer Ansett; Maithili Varadarajan; Priya Sekhon; James Cruise; Shivani Kanabar; Mirella Ling; Charlotte Milne; Jayanta Sarma; Aline Wilson; Lynn Urquhart; Sahar Eldirdiri; Leila White; Jody Aberdein; Phillip Simpson; Hnin Hay Mar; Keying Tan; Eint Shwe Zin thein; Mahmoud Aziz; Anthony Cadwgan; Natasha Weston; Salman Zeb; Angela Houston; Louise Wootton; Iona Willingham; Aimee Johnson; Ashley Horsley; Eamonn Trainor; Olivier Gaillemin; Nicholas J Norton; Katie Cheung; Megan Duxbury; Emilie Bellhouse; Helena Brezovjakova; Kanitkar Tanmay; Alexsander Dawidziuk; Razan Saman; Hugh Adler; Elshadai Ejere; Yiwen Soo; Wendy Beadles; Heather Sturgeon; Brodie Cameron; David Chadwick Ben Tomlinson; Claire McGoldrick; Katie McDowell; Mpho Molosiwa; Katherine FlackAdrian Kennedy; Phoebe Cross; Fay Perry; Vithusha Inpadhas; Sarathy Selvam; Vhairi Bateman; Henry Wu; Monika Pasztor; Ajanthiha Karunakaran; Basma Soliman; Andrew Blanshard; Harish Reddy; Helen Chesterfield; Ben Schroeder; Tee Keat Teoh; Sathyavani Subbarao; Caryn RosmarinLucy Bell; Emma McGuire; Robert Serafino; Ishaan Bhide; Karanjeet Sagoo; Indran Balakrishnan; Kajal Patel; Barzo Faris; Graeme Calver; Ricky Singh; Hazel Sanghvi; Mohamed Eltayeb; Rathur Haris
Source
BMJ Open, Vol 12, Iss 7 (2022)
Subject
Language
English
ISSN
2022-0626
2044-6055
2044-6055
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.