[A management analysis of bacterial meningitis in a hospital emergency service: the delay from the start of treatment and related factors].
OBJECTIVE
To establish the time elapsed from the patient arrival to the emergency room to the beginning of antibiotic therapy. To identify etiologic factors for treatment delay.


METHODS
73 patients diagnosed of bacterial meningitis in the emergency room and admitted to the hospital were studied. Patient characteristics as well as meningitis predisposing factors, symptoms, physical examination, laboratory data, radiological studies and previous ambulatory treatment, were recorded retrospectively. Arrival time, time expended at diagnostic procedures and time of administration of the first antibiotic dose, as well as the administration place were registered. Patients clinical evolution, and factors influencing the delay of antibiotic administration were analyzed.


RESULTS
Median age was 17 years. Patient care was evenly distributed along the day, 80% had a light base risk, 29% had at least a risk factor for meningitis, 22% received antibiotic previously. Clinical presentation was classic in more than 71% of patients. Blood cultures were positive in 41%, and CSF cultures were positive in 63%, 43% of cases were related to Neisseria meningitidis, 20% Streptococcus pneumoniae and unknown bacteria in 31.5%. Computerized Tomography (CT) was performed in 9 cases. Median time from the arrival to the Emergency Room until antibiotic administration was 5 hours and 25 minutes: When antibiotics were given before Lumbar Puncture (LP), it was 2 hours and 50 minutes, 5 hours 20 minutes when therapy was started after LP, and 7 hours and 22 minutes when CT was performed before LP. The only factor showing a statistically significant relation with the time to antibiotic administration was the patient being sent by the primary care physician to the hospital with a presumptive diagnosis of bacterial meningitis (1 hour 20 minutes vs. 5 hours 51 minutes).


CONCLUSIONS
Only a small part of bacterial meningitis cases start antibiotic treatment in the first 30 minutes. Delay is high and it increases when certain diagnostic tests are performed. Information received from the primary care physician, has the highest influence on the beginning of treatment.
Morano Amado
L E
LE
Servicio de Medicina Interna-Infecciosas, Hospital do Meixoeiro, Vigo.
Fernández Peña
C
C
del Campo Pérez
V
V
García García
M J
MJ
Hermida Díaz
A
A
López Miragaya
M I
MI
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors