Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study

J Bodilsen; C T Brandt; A Sharew; M Dalager-Pedersen; T Benfield; HC Schønheyder; H. Nielsen

doi:10.1016/j.cmi.2017.06.021

Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study

J Bodilsen, C T Brandt, A Sharew, M Dalager-Pedersen, T Benfield, HC Schønheyder, H. Nielsen

Institut for Klinisk Medicin

11 Citationer (Scopus)

Abstract

OBJECTIVES: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM).

METHODS: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality.

RESULTS: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5).

CONCLUSIONS: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.

Originalsprog	Engelsk
Tidsskrift	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Vol/bind	24
Udgave nummer	2
Sider (fra-til)	166-170
Antal sider	5
ISSN	1198-743X
DOI	https://doi.org/10.1016/j.cmi.2017.06.021
Status	Udgivet - feb. 2018

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10.1016/j.cmi.2017.06.021

http://www.clinicalmicrobiologyandinfection.com/article/S1198743X17303452/pdf

Citationsformater

Bodilsen, J., Brandt, C. T., Sharew, A., Dalager-Pedersen, M., Benfield, T., Schønheyder, HC., & Nielsen, H. (2018). Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 24(2), 166-170. https://doi.org/10.1016/j.cmi.2017.06.021

Early versus late diagnosis in community-acquired bacterial meningitis : a retrospective cohort study. / Bodilsen, J; Brandt, C T; Sharew, A et al.

I: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Bind 24, Nr. 2, 02.2018, s. 166-170.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Bodilsen, J, Brandt, CT, Sharew, A, Dalager-Pedersen, M, Benfield, T, Schønheyder, HC & Nielsen, H 2018, 'Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study', Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, bind 24, nr. 2, s. 166-170. https://doi.org/10.1016/j.cmi.2017.06.021

Bodilsen J, Brandt CT, Sharew A, Dalager-Pedersen M, Benfield T, Schønheyder HC et al. Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2018 feb.;24(2):166-170. doi: 10.1016/j.cmi.2017.06.021

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abstract = "OBJECTIVES: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM).METHODS: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality.RESULTS: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5).CONCLUSIONS: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.",

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T2 - a retrospective cohort study

AU - Bodilsen, J

AU - Brandt, C T

AU - Sharew, A

AU - Dalager-Pedersen, M

AU - Benfield, T

AU - Schønheyder, HC

AU - Nielsen, H.

PY - 2018/2

Y1 - 2018/2

N2 - OBJECTIVES: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM).METHODS: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality.RESULTS: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5).CONCLUSIONS: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.

AB - OBJECTIVES: To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM).METHODS: We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality.RESULTS: A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5).CONCLUSIONS: Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.

U2 - 10.1016/j.cmi.2017.06.021

DO - 10.1016/j.cmi.2017.06.021

M3 - Journal article

C2 - 28652113

SN - 1198-743X

VL - 24

SP - 166

EP - 170

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 2

ER -

Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study

Abstract

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