Community-acquired bacterial meningitis in adults: emergency department management protocol

Area of Science:

• Infectious Diseases
• Neurology
• Critical Care Medicine

Background:

• Acute bacterial meningitis (ABM) is a rare, disabling infection with high fatality rates (17-40%) in Belgium.
• Existing guidelines lack specific translation for Belgian emergency department (ED) practice.
• There is a need for a context-specific, multidisciplinary management protocol for ABM in the ED.

Purpose of the Study:

• To develop and implement a standardized, multidisciplinary protocol for managing community-acquired acute bacterial meningitis in the emergency department.
• To bridge the gap between evidence-based guidelines and daily clinical practice in a Belgian healthcare setting.
• To improve inter-disciplinary coordination and patient outcomes for ABM.

Main Methods:

• Formation of a multidisciplinary taskforce at University Hospitals Leuven, including experts in neurology, neurosurgery, intensive care, microbiology, and infectious diseases.
• Development of a seven-step management flowchart for emergency ABM care.
• Integration of practical guidance on lumbar puncture safety and intensive care referral criteria.

Main Results:

• A comprehensive protocol and flowchart for emergency ABM management were created and implemented.
• The protocol facilitates timely antimicrobial treatment and addresses practical ED challenges.
• Enhanced inter-disciplinary coordination in ABM patient care was fostered.

Conclusions:

• The developed protocol provides a practical, evidence-based framework for managing acute bacterial meningitis in the Belgian ED setting.
• Standardized protocols are crucial for optimizing multidisciplinary care and improving outcomes for severe infections like ABM.
• Implementation at University Hospitals Leuven demonstrates the feasibility and benefit of such coordinated approaches.