Antibiotic treatment delay and outcome in acute bacterial meningitis.
OBJECTIVE
To identify to what degree in-hospital delay of antibiotic therapy correlated to outcome in community acquired bacterial meningitis.


METHODS
All cases of culture-positive cerebrospinal fluids in east Denmark from 2002 to 2004 were included. Medical records were collected retrospectively with 98.4% case completeness. Glasgow Outcome Scale was used. Multiple regression outcome analyses included the hypothesised factors: delay of therapy, age, bacterial aetiology, adjuvant steroid therapy, coma at admission and the presence of risk factors.


RESULTS
One hundred and eighty seven cases were included. Adult mortality was 33% and the proportion of unfavourable outcome in adults was 52%, which differed significantly from that of children (<18 years) with a mortality of 3% (OR=15.8, 95% confidence interval: 3.7-67.6) and an unfavourable outcome of 14% (OR=12.7, CI: 4.3-37.2). Delay of antibiotic therapy correlated independently to unfavourable outcome (OR=1.09/h, CI: 1.01-1.19) among the 125 adult cases. In the group of adults receiving adequate antibiotic therapy within 12h (n=109), the independent correlation between antibiotic delay and unfavourable outcome was even more prominent (OR=1.30/h, CI: 1.08-1.57). The median delay to the first dose of adequate antibiotics was 1h and 39min (1h and 14min in children vs. 2h in adults, p<0.01), and treatment delay exceeded 2h in 21-37% of the cases with clinically evident meningitis.


CONCLUSIONS
The delay in antibiotic therapy correlated independently to unfavourable outcome. The odds for unfavourable outcome may increase by up to 30% per hour of treatment delay.
Køster-Rasmussen
Rasmus
R
Department of Infectious Diseases, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark. rasmuskoster@hotmail.com
Korshin
André
A
Meyer
Christian N
CN
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D003718:Denmark; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents