An audit of the investigation and initial management of adults presenting with possible bacterial meningitis.

Objectives: This study was carried out to determine local levels of compliance with guidelines from the British Infection Society (BIS) for the early management and investigation of adult patients presenting with possible bacterial meningitis [J Infect 39 (1999) 1; J Infect 46 (2003) 75].

Methods: Patients investigated for possible bacterial meningitis at Wythenshawe Hospital, Manchester were identified retrospectively by a computer search of microbiology requests. The clinical presentation, laboratory investigations and early antibiotic management were reviewed.

Results: Only two of 26 patients who presented over a 9-month period were confirmed to have bacterial meningitis. Basic laboratory investigations were carried out on all patients. Samples for more specific investigations to determine the aetiological agent such as polymerase chain reaction, serology or throat swab culture, were frequently omitted by the clinicians. The choice of antibiotic therapy was generally appropriate for the treatment of bacterial meningitis with large variation in the dosage prescribed. Both patients with confirmed bacterial meningitis received appropriate doses.

Conclusions: Compliance with BIS guidelines was incomplete in a group of patients presenting with possible bacterial meningitis. Access to a simplified outline of recommendations for early investigation and management of adult patients with possible bacterial meningitis may optimise guideline compliance and patient outcome.

Summary: Appropriate early investigation and management of bacterial meningitis in adults can optimise the outcome of this high mortality disease. Guidelines published by the BIS in 1999 detailed the recommended initial management of such patients [J Infect 39 (1999) 1]. In this study, the level of adherence to these guidelines was investigated for patients with possible bacterial meningitis who presented to a hospital in Manchester. The results showed that basic investigations such as peripheral blood count and blood cultures were almost invariably carried out, whereas, more specific investigations such as meningococcal PCR, serology and throat swab were frequently omitted. The choice of antibiotic was in agreement with the guidelines for the majority of cases but highlighted a considerable variability in dosage prescribed. The availability of a simple flow-chart outlining the early management of suspected bacterial meningitis and meningococcal septicaemia in adults produced by the BIS in 2003 may raise awareness of and compliance with their guidelines, thus optimising patient outcome.