An audit of local practice in suspected bacterial meningitis and meningococcal septicaemia at a UK university teaching hospital

Abstract

Objective: To examine if national guidelines around the management, investigation and follow up of minors with presumed meningitis and meningococcal septicaemia are followed. Methods: Standards were derived from UK national guidelines, and Meningitis Research Foundation algorithms. Retrospective data was collected from 37 children (1 week–13 years) hospitalised between 2010–2015, excluding external transfers. Results: In primary care, intramuscular benzyl-penicillin was given in 43% of children with non-blanching rash. Mean time from arrival to IV antibiotics was 177 minutes. Fluid bolus was given in 18 cases, initially as 20ml/kg in 55%. Average time to next bolus in 13 cases was 64 minutes, with documented clinical review post first bolus in 50%. Inotropes were required in 7 cases (19%). Use of corticosteroids for meningitis occurred in 2 of 4 indicated cases. Meningococcal blood PCR was taken in 76% and blood cultures in 97%. Lumbar punctures were performed in 8 of 11 suspected cases of meningitis, with 6 taken on average 42 hours post IV antibiotics. Neisseria meningitidis was cultured in 5 lumbar punctures, with blood PCR positive in 19 of 28 and blood culture positive in 12 of 36 cases. Contact prophylaxis was given in 83%. Duration of IV antibiotics was 7 days in majority (67%), with 14% receiving 10–14 day course and one requiring a 6 week course. Main complication was coagulopathy in 62%, with two cases having subdural collections, one skin necrosis and one limb amputation. Severn patients required local PICU care, two patients were transferred out and one patient sadly died. Follow up occurred in 44%, with audiology screening in 39%. Conclusion: Management of meningococcal disease still varies widely. Follow up in this group was suboptimal, despite clear national guidelines. We presented our findings locally, highlighting areas for improvement. We aim to re-audit this cohort in 12 months time.