Méningites bactériennes : facteurs associés au délai d’instauration d’une antibiothérapie adaptée aux urgences

Objectives

We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.

Methods

Our retrospective observational study (2009–2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.

Results

We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 1h09–5h57]; admission/antimicrobials, 3h21 1h34–5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P = 0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P = 0.05).

Conclusions

Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.