Adjunctive steroid treatment: local guidelines and patient outcome in adult bacterial meningitis

TY - JOUR

T1 - Adjunctive steroid treatment

T2 - local guidelines and patient outcome in adult bacterial meningitis

AU - Korshin, André

AU - Køster-Rasmussen, Rasmus

AU - Meyer, Christian N

AU - Danish Bacterial Meningitis Group

PY - 2007

Y1 - 2007

N2 - Our objective was to evaluate local guidelines regarding early steroid treatment in adult community acquired bacterial meningitis, and assess the actual treatment given and its correlation to clinical outcome. Patient outcome was obtained retrospectively from the medical records of 210 adults admitted to 47 hospitals in Denmark during 2002-2004 (population 5.4 million) and was combined with results from a questionnaire regarding treatment guidelines in these hospitals. In 36 of 47 departments responding to the questionnaire, 21 recommended early steroid treatment, but none did so initially during 2002. Early steroid treatment was given to 15% of patients and was given more often when recommended locally (41% vs 11%, OR=5.7 (2.4-13.5)). Unfavourable outcome was demonstrated rarely in patients treated with early steroids compared to the non-steroid group (17% vs 42%, p<0.05). In the 32 cases with petechial skin lesions, these were caused by pneumococci (15), meningococci (15), Staphylococcus aureus (1) and enterococci (1), and thus the presence of such lesions should not make the clinician abstain from early steroid treatment of bacterial meningitis. In conclusion, concordance with the new consensus of early steroid treatment was poor on a national basis, and better (41%) when adequate local guidelines were available. Early steroid treatment was associated with favourable outcome, and improved implementation of adequate guidelines may contribute to better patient outcome in bacterial meningitis.

AB - Our objective was to evaluate local guidelines regarding early steroid treatment in adult community acquired bacterial meningitis, and assess the actual treatment given and its correlation to clinical outcome. Patient outcome was obtained retrospectively from the medical records of 210 adults admitted to 47 hospitals in Denmark during 2002-2004 (population 5.4 million) and was combined with results from a questionnaire regarding treatment guidelines in these hospitals. In 36 of 47 departments responding to the questionnaire, 21 recommended early steroid treatment, but none did so initially during 2002. Early steroid treatment was given to 15% of patients and was given more often when recommended locally (41% vs 11%, OR=5.7 (2.4-13.5)). Unfavourable outcome was demonstrated rarely in patients treated with early steroids compared to the non-steroid group (17% vs 42%, p<0.05). In the 32 cases with petechial skin lesions, these were caused by pneumococci (15), meningococci (15), Staphylococcus aureus (1) and enterococci (1), and thus the presence of such lesions should not make the clinician abstain from early steroid treatment of bacterial meningitis. In conclusion, concordance with the new consensus of early steroid treatment was poor on a national basis, and better (41%) when adequate local guidelines were available. Early steroid treatment was associated with favourable outcome, and improved implementation of adequate guidelines may contribute to better patient outcome in bacterial meningitis.

KW - Adolescent

KW - Adrenal Cortex Hormones/therapeutic use

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents/therapeutic use

KW - Female

KW - Hospitals

KW - Humans

KW - Male

KW - Meningitis, Bacterial/drug therapy

KW - Middle Aged

KW - Practice Guidelines as Topic

KW - Retrospective Studies

KW - Surveys and Questionnaires

KW - Treatment Outcome

U2 - 10.1080/00365540701449393

DO - 10.1080/00365540701449393

M3 - Journal article

C2 - 17852945

SN - 0300-8878

VL - 39

SP - 963

EP - 968

JO - Scandinavian Journal of Infectious Diseases, Supplement

JF - Scandinavian Journal of Infectious Diseases, Supplement

IS - 11-12

ER -