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Implementation of a Meningitis Care Bundle in the Emergency Room Reduces Mortality Associated With Acute Bacterial
Pierluigi Viale1, Luigia Scudeller2, Federico Pea3
1Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy.
Background:
Prompt administration of antibiotics, adjunctive steroid therapy, and optimization of antibiotic delivery to cerebrospinal fluid (CSF) are factors associated with improved outcome of patients hospitalized for acute bacterial meningitis (ABM). However, the impact of a bundle of these procedures has not been reported.
Objective:
To assess mortality and neurological sequelae at hospital discharge in a cohort of patients with ABM managed according to a predefined bundle.
Methods:
Prospective study of all the patients hospitalized for ABM in two provinces of Northern Italy, over two consecutive periods (2005-2009, 2010-2013). The bundle included: i) supportive care if needed; ii) immediate administration of dexamethasone and 3rd generation cephalosporin; and iii) addition of levofloxacin if turbid CSF. Patients managed according to the bundle were compared with a historical group of patients cared for ABM before the bundle was implemented.
Results:
Overall, 85 patients with ABM were managed according to the bundle and were compared with 92 historical controls. In-hospital mortality rates for bundle and control group were 4.7% and 14.1% (p=0.04). Among survivors, 13.5% and 18.9% (p=0.4) of bundle and control-group patients presented neurological sequelae. The only variable associated with mortality at multivariate analysis was ICU admission (HR 3.65). After adjusting for ICU admission, patients managed according with the ABM bundle had significantly lower mortality rate compared to historical controls.
Conclusions:
Use of a bundled protocol and antibiotics with excellent CSF penetration for the initial management of ABM in emergency department is feasible and associated with significant reduction in mortality.
Insights
Implementing a bundled protocol for acute bacterial meningitis (ABM) significantly reduced in-hospital mortality. This approach combines prompt antibiotics and steroid therapy, improving patient outcomes in emergency settings.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Prompt antibiotic administration, adjunctive steroid therapy, and optimized antibiotic delivery to cerebrospinal fluid (CSF) are known factors improving outcomes in acute bacterial meningitis (ABM).
- The combined impact of these interventions, delivered as a protocol bundle, had not been previously reported.
Purpose of the Study:
- To evaluate the effectiveness of a predefined management bundle for acute bacterial meningitis (ABM).
- To assess the impact of this bundle on in-hospital mortality and neurological sequelae at hospital discharge.
Main Methods:
- A prospective study compared patients with ABM managed with a bundle (supportive care, immediate dexamethasone and cephalosporin, optional levofloxacin for turbid CSF) to a historical control group.
- The study included patients from two Northern Italy provinces over two periods (2005-2009 and 2010-2013).
Main Results:
- The bundle group (85 patients) showed a significantly lower in-hospital mortality rate (4.7%) compared to the control group (92 patients, 14.1%; p=0.04).
- Neurological sequelae rates were similar between groups (13.5% vs 18.9%; p=0.4).
- Multivariate analysis identified ICU admission as the only variable associated with mortality; however, the ABM bundle remained associated with significantly lower mortality after adjustment.
Conclusions:
- A bundled protocol for initial ABM management in the emergency department is feasible.
- This bundled approach, utilizing antibiotics with excellent CSF penetration, is associated with a significant reduction in mortality for acute bacterial meningitis.
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