Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis

BACKGROUND: Bacterial meningitis continues to cause high mortality. Few studies address the possible association between this mortality and antibiotic administration delays. AIM: To determine whether delays in antibiotic administration are associated with mortality from bacterial meningitis, and to identify inappropriate diagnostic-treatment sequences leading to such delays. DESIGN: Retrospective case record study. METHODS: We reviewed 123 cases of adult acute bacterial meningitis in 119 patients aged >/=16 years admitted to hospital from January 1990 to March 2002, using multivariate regression analysis to assess the association between meningitis mortality and door-to-antibiotic time (the time elapsed between emergency room presentation and antibiotics administration). RESULTS: The case fatality rate was 13% (16/123). Adjusted odds ratios (OR) for mortality were: 8.4 (95%CI 1.7-40.9) for door-to-antibiotic time >6 h; 39.4 (95%CI 4.3-358.1) for afebrility at presentation; and 12.6 (95%CI 2.2-72.0) for severely impaired mental status at presentation. Factors associated with a door-to-antibiotic time of >6 h were: (i) failure to administer antibiotics prior to transfer from another institution (OR 21.8); (ii) the diagnostic-treatment sequence: head CT then lumbar puncture, then antibiotics (OR 5.6); and (iii) the absence of the classic meningitis triad (OR 4.9). DISCUSSION: There is an independent incremental association between delays in administrating antibiotics and mortality from adult acute bacterial meningitis. Inappropriate diagnostic-treatment sequences were significant predictors of such treatment delays.