Pre-admission penicillin in patients with meningitis or meningococcal disease
Abstract number: 1733_1598
Darville J.M., Lovering A.M., MacGowan A.P.
Objectives: UK government guidelines recommend that patients with suspected meningitis or meningococcal disease receive intra-muscular penicillin before admission to hospital. This study assesses adherence to these guidelines by determining the frequency of such antibiotic use in the area served by North Bristol Trust hospitals in a 6 year period.
Methods: Laboratory computer records were searched for patients from whom Neisseria meningitidis was isolated from any sample, and for those from whom Streptococcus pneumoniae or Haemophilusinfluenzae were isolated from CSF samples. Hospital computer records were searched for patients for whom the final diagnosis was infectious meningitis. Personal, demographic, clinical and therapeutic data were extracted from patients' hospital notes. To estimate the extent of pre-admission illness, 10 presenting symptoms consistent with meningitis or meningococcal disease were each allocated one point. The data were transferred to a data-base for analysis.
Results: Mean severity scores are in brackets. 57 patients (2.9) did not see a doctor (medical practitioner) pre-admission. 7 of these had meningococcal septicaemia, 46 had meningitis (15 meningococcal) and 2 had meningococcal infection. 149 patients (3.36) did see a doctor. 40 (3.75) of these had antibiotic and 109 (3.21) did not. Of the 40, 4 had septicaemia (all meningococcal) and 35 had meningitis (11 meningococcal). Of the 109, 13 had septicaemia (all meningococcal) and 90 had meningitis (29 meningococcal).
72 patients (3.15) had meningococcal disease. 48 (3.15) of these saw a doctor, 24 (3.17) did not. Of the 48, 15 (3.67) had antibiotic, 33 (2.91) did not.
46 (3.44) patients with rash saw a doctor.18 (3.72) of these had antibiotic, 28 (3.25) did not. Of 32 (3.28) patients with meningococcal disease and rash seeing a doctor, 13 (3.69) had antibiotic, 19 (3.0) did not.
175 patients (3.3) had meningitis. 125 (3.47) of these saw a doctor, and of these 35 (3.77) had antibiotic, 90 (3.36) did not.
Conclusions: Patients may be more likely to receive pre-admission antibiotic the more symptoms they present with, when a rash is present or when Neisseria meningitidis is subsequently isolated. However, the majority of patients with meningitis or meningococcal disease seeing a doctor before admission did not receive antibiotic. Our study suggests that the guidelines have not been adequately observed and that it may necessary to revise them.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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