Antibiotic treatment delay and outcome in acute bacterial meningitis

Objectives: To identify to what degree in-hospital delay of antibiotic therapy correlated to outcome in community acquired bacterial meningitis. Methods: All cases of culture-positive cerebrospinal fluids in east Denmark from 2002 to 2004 were included. Medical records were collected retrospectively with 98.4% case completeness. Glasgow Outcome Scale was used. Multiple regression outcome analyses included the hypothesised factors: delay of therapy, age, bacterial aetiology, adjuvant steroid therapy, coma at admission and the presence of risk factors. Results: One hundred and eighty seven cases were included. Adult mortality was 33% and the proportion of unfavourable outcome in adults was 52%, which differed significantly from that of children (<18 years) with a mortality of 3% (OR = 15.8, 95% confidence interval: 3.7-67.6) and an unfavourable outcome of 14% (OR = 12.7, CI: 4.3-37.2). Delay of antibiotic therapy correlated independently to unfavourable outcome (OR = 1.09/h, CI: 1.01-1.19) among the 125 adult cases. In the group of adults receiving adequate antibiotic therapy within 12 h (n = 109), the independent correlation between antibiotic delay and unfavourable outcome was even more prominent (OR = 1.30/h, CI: 1.08-1.57). The median delay to the first dose of adequate antibiotics was 1 h and 39 min (1 h and 14 min in children vs. 2 h in adults, p < 0.01), and treatment delay exceeded 2 h in 21-37% of the cases with clinically evident meningitis. Conclusion: The delay in antibiotic therapy correlated independently to unfavourable outcome. The odds for unfavourable outcome may increase by up to 30% per hour of treatment delay. (C) 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.