[Bacterial meningitis in emergency medicine. Factors associated with delay of antimicrobial therapy].
BACKGROUND
Bacterial meningitis is a severe infection. Outcome might be improved if diagnosis and therapy are achieved promptly. We studied the time elapsed until antimicrobial therapy and analyzed factors associated to delay.


METHODS
We performed a retrospective study of bacterial meningitis diagnosed in a hospital emergency medicine department in two consecutive years. Dependent variable was time since admission to antimicrobial therapy; delay was defined as time to administration longer than 2 h. The relationship between clinical variables and delay was studied with bivariate analysis. Significative variables were included in a multivariate analysis using multiple logistic regression.


RESULTS
We studied 40 cases of bacterial meningitis (67.5% female, mean age 25.2 years). The mean time to antibiotic therapy was 127 min; in 16 patients (40%; 95% confidence interval: 25-56%) delay was 2 h or more. In bivariate analysis differences were observed for age (15.5 +/- 24.2 vs 39.7 +/- 28.7 years; p < 0.01), temperature (38.7 +/- 1 vs 38 +/- 1.1 degrees C; p < 0.05), mean blood pressure (77 +/- 14 vs 91 +/- 20 mmHg; p < 0.05), headache (29% vs 75%; p < 0.01), meningeal signs (63% vs 19%; p < 0.01), skin lesions (60% vs 13%; p < 0.01), "sick" presentation (67% vs 19%; p < 0.01), performance of CT scan (8% vs 38%; p < 0.05) and appropriateness of management (96% vs 44%; p < 0.001). In multivariate analysis only absence of skin lesions and inappropriate management remained significative. Mortality was higher when there was a delay of more than 2 h in antimicrobial therapy (25% vs 0%; p < 0.05).


CONCLUSIONS
Factors associated with delay of antimicrobial therapy were the absence of skin lesions and inappropriate management.
Gutiérrez
A
A
Servicio de Urgencias, Hospital de Basurto, Bilbao.
Ramos
M A
MA
Sanz
J C
JC
Bernal
A
A
Agirrezabal
J
J
Casado
Y
Y
Martínez
M
M
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents