LAUSR

BACKGROUND Bacterial meningitis is a medical emergency and timely management has been shown to improve outcomes. The aim of this study was to compare the early assessment and management of adults with suspected community-onset meningitis between hospitals and identify opportunities for clinical practice improvement. METHODS This retrospective cohort study was conducted at three principal referral hospitals in Sydney, Australia. Adult patients with suspected meningitis undergoing cerebrospinal fluid (CSF) sampling between 1 July 2018 and 31 June 2019 were included. Relevant clinical and laboratory data were extracted from the medical record. Differences between sites were analysed and factors associated with time to antimicrobial therapy assessed by Cox regression. RESULTS In 260 patients, median time from triage to antibiotic administration was 332 minutes with a difference of up to 147 minutes between hospitals. Median time from triage to lumbar puncture (LP) was 366 minutes with an inter-hospital difference of up to 198 minutes. Seventy percent of patients had neuroimaging prior to LP, and this group had a significantly longer median time to antibiotic administration (367 vs 231 minutes; p=0.001). Guideline concordant antibiotics were administered in 84% of patients, with only 39% of those administered adjunctive corticosteroids. Seven patients (3%) had confirmed bacterial meningitis. Modifiable factors associated with earlier antimicrobial administration included Infectious Diseases involvement (aHR 1.50; 95% CI 1.01-2.24)) and CT scanning (aHR 0.67; 95% CI 0.46-0.98). CONCLUSION Opportunities for improvement include reducing the time to LP and antibiotic administration, improving co-administration of corticosteroids and avoiding potentially unnecessary CT scanning. This article is protected by copyright. All rights reserved.