Management of severe community-acquired septic meningitis in adults: from emergency department to intensive care unit.
OBJECTIVE
To study the clinical features, diagnostic processes, timing of antibiotic administration and outcomes of patients with severe community-acquired septic meningitis at an emergency department (ED), who required intensive care unit (ICU) admission.


METHODS
From January 1993 to December 2005, the medical records of patients admitted to the ICU with a diagnosis of community-acquired septic meningitis were reviewed. The clinical characteristics, including causative pathogens, treatment course, and outcomes were collected and analyzed.


RESULTS
A total of 40 patients were included, with an overall in-hospital mortality rate of 77.5%. The most common pathogen was Klebsiella pneumoniae (n=20, 50%), followed by Streptococcus pneumoniae (n=6, 15%), and Cryptococcus neoformans (n=5, 12.5%). There was a mean duration of 8.9 hours between ED arrival and initiation of antibiotic therapy. Effective antibiotics were administered for a mean period of 23.8 hours after arrival. Time delay from ED arrival to ICU admission was correlated with time delay of effective antibiotics administration, head computed tomography, and cerebrospinal fluid study (r=0.32, 0.47, and 0.53, respectively; p=0.05, 0.006, and 0.001, respectively). Earlier ICU admission was demonstrated in survivors as compared with those who died (11.1 vs. 38.0 hours, p=0.01).


CONCLUSIONS
Severe septic meningitis remains a disease with high mortality and morbidity. Expeditious diagnostic processes with early appropriate antibiotic treatment and ICU admission at the ED are important in improving the quality of care and patient outcome.
Hsu
Chia-Lin
CL
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chang
Chia-Hsuin
CH
Wong
King-Nang
KN
Chen
Kuan-Yu
KY
Yu
Chong-Jen
CJ
Yang
Pan-Chyr
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D004334:Drug Administration Schedule; D004365:Drugs, Chinese Herbal; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008581:Meningitis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004365:Drugs, Chinese Herbal; C513940:taizhi'an