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

Department of Clinical Medicine

11 Citations (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.

Original language	English
Journal	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Volume	24
Issue number	2
Pages (from-to)	166-170
Number of pages	5
ISSN	1198-743X
DOIs	https://doi.org/10.1016/j.cmi.2017.06.021
Publication status	Published - Feb 2018

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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.
In: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, Vol. 24, No. 2, 02.2018, p. 166-170.

Research output: Contribution to journal › Journal article › Research › 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, vol. 24, no. 2, pp. 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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AU - Bodilsen, J

AU - Brandt, C T

AU - Sharew, A

AU - Dalager-Pedersen, M

AU - Benfield, T

AU - Schønheyder, HC

AU - Nielsen, H.

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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.

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DO - 10.1016/j.cmi.2017.06.021

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SN - 1198-743X

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JO - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

IS - 2

ER -

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

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