Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis
| Autor: | Fréchette D, Chan J, Proulx N, Baldwin Toye, Kravcik S |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Patient Transfer Pediatrics medicine.medical_specialty Time Factors Fever medicine.drug_class Antibiotics Spinal Puncture Meningitis Bacterial Anti-Infective Agents Case fatality rate medicine Odds Ratio Humans Intensive care medicine Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Lumbar puncture Mental Disorders Retrospective cohort study General Medicine Odds ratio Middle Aged medicine.disease Acute bacterial meningitis Cephalosporins Acute Disease Regression Analysis Bacterial meningitis Female business Tomography X-Ray Computed Meningitis |
| Zdroj: | QJM : monthly journal of the Association of Physicians. 98(4) |
| ISSN: | 1460-2725 |
| Popis: | Background: Bacterial meningitis continues to cause high mortality. Few studies address the possible association between this mortality and antibiotic administration delays. Aim: To determine whether delays in antibiotic administration are associated with mortality from bacterial meningitis, and to identify inappropriate diagnostic–treatment sequences leading to such delays. Design: Retrospective case record study. Methods: We reviewed 123 cases of adult acute bacterial meningitis in 119 patients aged ⩾16 years admitted to hospital from January 1990 to March 2002, using multivariate regression analysis to assess the association between meningitis mortality and door-to-antibiotic time (the time elapsed between emergency room presentation and antibiotics administration). Results: The case fatality rate was 13% (16/123). Adjusted odds ratios (OR) for mortality were: 8.4 (95%CI 1.7–40.9) for door-to-antibiotic time >6 h; 39.4 (95%CI 4.3–358.1) for afebrility at presentation; and 12.6 (95%CI 2.2–72.0) for severely impaired mental status at presentation. Factors associated with a door-to-antibiotic time of >6 h were: (i) failure to administer antibiotics prior to transfer from another institution (OR 21.8); (ii) the diagnostic–treatment sequence: head CT then lumbar puncture, then antibiotics (OR 5.6); and (iii) the absence of the classic meningitis triad (OR 4.9). Discussion: There is an independent incremental association between delays in administrating antibiotics and mortality from adult acute bacterial meningitis. Inappropriate diagnostic–treatment sequences were significant predictors of such treatment delays. |
| Databáze: | OpenAIRE |
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