uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Adult Bacterial Meningitis: Earlier Treatment and Improved Outcome Following Guideline Revision Promoting Prompt Lumbar Puncture
Show others and affiliations
2015 (English)In: Clinical Infectious Diseases, ISSN 1058-4838, Vol. 60, no 8, 1162-1169 p.Article in journal (Refereed) Published
Abstract [en]

Background. In suspected acute bacterial meningitis (ABM), cerebral computerized tomography (CT) is recommended before lumbar puncture (LP) if mental impairment. Despite guideline emphasis on early treatment, performing CT prior to LP implies a risk of delayed treatment and unfavorable outcome. Therefore, Swedish guidelines were revised in 2009, deleting impaired mental status as a contraindication for LP without prior CT scan. The aim of the present study was to evaluate the guideline revision. Methods. The Swedish quality registry for community-acquired ABM was analyzed retrospectively. Door-to-antibiotic time and outcome were compared among patients treated 2005-2009 (n = 394) and 2010-2012 (n = 318). The effect of different LP-CT sequences was analyzed during 2008-2012. Results. Adequate treatment was started 1.2 hours earlier, and significantly more patients were treated <2 hours from admission 2010-2012 than 2005-2009. Compared with CT before LP, immediate LP resulted in 1.6 hours earlier treatment, significant increase in door-to-antibiotic times of <1 and <2 hours, and a favorable outcome. In 2010-2012, mortality was lower (6.9% vs 11.7%) and the risk of sequelae at follow-up decreased (38% vs 49%) in comparison with 2005-2009. Treatment delay resulted in a significantly increased risk for fatal outcome, with a relative increase in mortality of 12.6% per hour of delay. Conclusions. The deletion of impaired mental status as contraindication for prompt LP and LP without prior CT scan are associated with significantly earlier treatment and a favorable outcome. A revision of current international guidelines should be considered.

Place, publisher, year, edition, pages
2015. Vol. 60, no 8, 1162-1169 p.
Keyword [en]
bacterial meningitis, lumbar puncture, guidelines, time to treatment, outcome
National Category
Infectious Medicine
URN: urn:nbn:se:uu:diva-253253DOI: 10.1093/cid/civ011ISI: 000353715600005PubMedID: 25663160OAI: oai:DiVA.org:uu-253253DiVA: diva2:820818
Available from: 2015-06-12 Created: 2015-05-25 Last updated: 2015-06-12Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Sjölin, Jan
By organisation
Infectious Diseases
In the same journal
Clinical Infectious Diseases
Infectious Medicine

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 193 hits
ReferencesLink to record
Permanent link

Direct link