title: Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis.
abstract: BACKGROUND
  Bacterial meningitis continues to cause high mortality. Few studies address the possible association between this mortality and antibiotic administration delays.
  
  
  OBJECTIVE
  To determine whether delays in antibiotic administration are associated with mortality from bacterial meningitis, and to identify inappropriate diagnostic-treatment sequences leading to such delays.
  
  
  METHODS
  Retrospective case record study.
  
  
  METHODS
  We reviewed 123 cases of adult acute bacterial meningitis in 119 patients aged >/=16 years admitted to hospital from January 1990 to March 2002, using multivariate regression analysis to assess the association between meningitis mortality and door-to-antibiotic time (the time elapsed between emergency room presentation and antibiotics administration).
  
  
  RESULTS
  The case fatality rate was 13% (16/123). Adjusted odds ratios (OR) for mortality were: 8.4 (95%CI 1.7-40.9) for door-to-antibiotic time >6 h; 39.4 (95%CI 4.3-358.1) for afebrility at presentation; and 12.6 (95%CI 2.2-72.0) for severely impaired mental status at presentation. Factors associated with a door-to-antibiotic time of >6 h were: (i) failure to administer antibiotics prior to transfer from another institution (OR 21.8); (ii) the diagnostic-treatment sequence: head CT then lumbar puncture, then antibiotics (OR 5.6); and (iii) the absence of the classic meningitis triad (OR 4.9).
  
  
  CONCLUSIONS
  There is an independent incremental association between delays in administrating antibiotics and mortality from adult acute bacterial meningitis. Inappropriate diagnostic-treatment sequences were significant predictors of such treatment delays.
authors.affiliation: Departmetn of Medicine, University of Western Ontario, London, Canada. nproulx@uwo.ca
authors.forename: N
authors.initials: N
authors.lastname: Proulx
authors.forename: D
authors.initials: D
authors.lastname: Fréchette
authors.forename: B
authors.initials: B
authors.lastname: Toye
authors.forename: J
authors.initials: J
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Kravcik
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D016017:Odds Ratio; D010360:Patient Transfer; D012044:Regression Analysis; D012189:Retrospective Studies; D013129:Spinal Puncture; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins