title: Pre-hospital parenteral antibiotic treatment of meningococcal disease and case fatality: a Danish population-based cohort study.
abstract: OBJECTIVE
  Studies about the efficiency of pre-hospital antibiotic treatment of meningococcal disease are conflicting. We examined the case fatality rate in patients with meningococcal disease treated with pre-hospital antibiotics.
  
  
  METHODS
  A cohort study of 534 patients hospitalized with meningococcal disease from two Danish counties. Clinical data were obtained from referral letters from general practitioners and hospital records. Complete follow-up for all patient until death or discharge.
  
  
  RESULTS
  Seventy-seven patients (16% of the patients seen by a general practitioner) received parenteral antibiotics before hospital admission; 9 (12%) of them died. Of 402 patients who did not receive pre-hospital parenteral antibiotics, 26 (7%) died. The overall risk of case fatality among antibiotic-treated patients was increased with adjusted odds ratio (OR) = 2.4 (95% CI, 1.0-5.6). Meningococcus serogroup B was associated with increased case fatality in patients who received pre-hospital parenteral antibiotics (OR = 2.6; 95% CI, 0.8-8.3) in contrast to other serogroups. In Aarhus County there were no deaths in patients who received pre-hospital parenteral antibiotics, but in North Jutland County the case fatality was high (OR = 2.9; 95% CI, 1.2-6.8).
  
  
  CONCLUSIONS
  The efficiency of pre-hospital parenteral antibiotic treatment seems to be dependent on hospital care and may vary with the serogroup.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. bn@soci.au.dk
authors.forename: B
authors.initials: B
authors.lastname: Nørgård
authors.forename: H T
authors.initials: HT
authors.lastname: Sørensen
authors.forename: E S
authors.initials: ES
authors.lastname: Jensen
authors.forename: T
authors.initials: T
authors.lastname: Faber
authors.forename: H C
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: G L
authors.initials: GL
authors.lastname: Nielsen
mesh_terms: D000293:Adolescent; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D018672:Community Health Planning; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral / Q000379:methods; D008297:Male; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D009026:Mortality; D009345:Neisseria meningitidis / Q000472:pathogenicity; D012307:Risk Factors; D012698:Serologic Tests / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents