title: Meningococcal disease deaths and the frequency of antibiotic administration delays.
abstract: OBJECTIVE
  Meningococcal disease (MCD) remains a medical emergency and a frequent cause of death in previously healthy individuals. We aimed to determine the frequency and cause of delays in antibiotic administration in a cohort of deaths.
  
  
  METHODS
  A retrospective chart review was undertaken on 140 hospitalised MCD deaths within New Zealand's serogroup B epidemic (1993-2004).
  
  
  RESULTS
  Death after hospital presentation occurred rapidly (median 12 h) with 70% dying within 24 h. Delays of more than 2 h in time-to-antibiotic post hospital presentation occurred in 29%. The major contributors to these delays were the failure to include MCD within the differential diagnosis and prolonged assessment times. Multivariate logistic regression analysis, undertaken by combining study deaths which had meningococcal bacterial load results (n=9) with a survivor cohort (n=126) from a previous study, confirmed bacterial load as a major predictor of death (OR 7.5 per log10 cfu/mL increase; 95% CI 2.2-25.3; p=0.001). A non-significant increased risk of death per hour of antibiotic delay was seen (OR 1.18; 95% CI 0.90-1.55; p=0.22).
  
  
  CONCLUSIONS
  Death from MCD occurred rapidly, with many patients not receiving antibiotics at the earliest opportunity. The introduction of recently developed rapid diagnostic markers into the identified delay-intervals could lead to a reduction in time-to-antibiotic and hopefully reduce case-fatality rates.
authors.affiliation: Auckland School of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Hamish M
authors.initials: HM
authors.lastname: Lala
authors.forename: Graham D
authors.initials: GD
authors.lastname: Mills
authors.forename: Kevin
authors.initials: K
authors.lastname: Barratt
authors.forename: John
authors.initials: J
authors.lastname: Bonning
authors.forename: Noel E
authors.initials: NE
authors.lastname: Manikkam
authors.forename: Diana
authors.initials: D
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D008589:Meningococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D009345:Neisseria meningitidis / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial