Factors associated with treatment delay and outcome in community acquired bacterial meningitis

Nichlas Hovmand; Lene Fogt Lundbo; Gitte Kronborg; Perle Darsø; Thomas Benfield

doi:10.1016/j.ijregi.2023.03.013

Factors associated with treatment delay and outcome in community acquired bacterial meningitis

IJID Reg. 2023 Mar 24:7:176-181. doi: 10.1016/j.ijregi.2023.03.013. eCollection 2023 Jun.

Authors

Nichlas Hovmand^{1

2}, Lene Fogt Lundbo¹, Gitte Kronborg³, Perle Darsø⁴, Thomas Benfield^{1

2}

Affiliations

¹ Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
² Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
³ Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
⁴ Center for Health, Capital Region of Denmark, Kongens Vænge 2, 3400, Hillerød, Denmark.

Abstract

Background: Community acquired bacterial meningitis (CABM) is a condition associated with significant morbidity and mortality. Treatment delay remains an area of concern and might be improved by awareness of meningitis among health care professionals.

Methods: Retrospective observational study of patients with CABM between 2016 and 2021 in Eastern Denmark with a population of 2,700,000. Data was extracted from electronic health records. Treatment delay and mortality was analyzed using multivariate logistic regression and expressed as odds ratio (OR) with 95% confidence intervals (CI).

Results: Of 369 patients 226 (61%) had treatment delayed more than 2 hours. Old age (OR 2.42, CI 1.22;4.77), comorbidity (OR 1.30, CI 1.00;1.70), suspicion of other infections than meningitis (OR 65.93, CI 20.68;210.20), stroke (OR 7.24, CI 3.11;16.86) and other diagnoses (OR 13.00, CI 5.07;33.31) were associated with delayed treatment. Treatment delay was associated with increased 30-day mortality (OR 3.07, 95% CI 1.09;8.67). Most of the treatment delay (82%) was due lack of suspicion of CABM.

Conclusions: Treatment delay is a common problem associated with 30-day mortality in CABM. Awareness of CABM in undiagnosed patients is vital to achieve timely initiation of appropriate treatment. Special care should be shown for patients suspected of stroke or other infections.

Keywords: Fever; Hospital care; Infection; Meningitis; Treatment delay.