TY - JOUR
T1 - Early versus late diagnosis in community-acquired bacterial meningitis
T2 - A retrospective cohort study
AU - Bodilsen, Jacob
AU - Brandt, Christian Thomas
AU - Sharew, Andrew
AU - Dalager-Pedersen, Michael
AU - Benfield, Thomas
AU - Schønheyder, Henrik Carl
AU - Nielsen, Henrik
N1 - Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Objectives: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM). Methods: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality. Results: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2–2.5). Conclusions: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.
AB - Objectives: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM). Methods: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality. Results: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2–2.5). Conclusions: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.
KW - Journal Article
KW - Treatment delay
KW - Bacterial meningitis
KW - Cranial imaging
KW - Outcome
KW - Diagnostic delay
KW - Late diagnosis
KW - Hospital Mortality
KW - Humans
KW - Middle Aged
KW - Male
KW - Treatment Outcome
KW - Time Factors
KW - Denmark
KW - Meningitis, Bacterial/diagnosis
KW - Adult
KW - Delayed Diagnosis/adverse effects
KW - Female
KW - Aged
KW - Retrospective Studies
KW - Early Diagnosis
KW - Community-Acquired Infections/diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85028331253&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2017.06.021
DO - 10.1016/j.cmi.2017.06.021
M3 - Journal article
C2 - 28652113
SN - 1198-743X
VL - 24
SP - 166
EP - 170
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 2
ER -