Management Of Bacterial Meningitis Research Articles

Diagnosis and management of bacterial meningitis in adult Sudanese patients: a six years hospital based, retrospective, cross-sectional study

PurposeTo evaluate the diagnosis and management of bacterial meningitis in adult Sudanese patients in accordance with the Infectious Diseases Society of America (IDSA) guidelines for bacterial meningitis management.Patients and methodsA cross-sectional, retrospective study design was used to recruit all patients aged > 18 years who were diagnosed with or suspected of having bacterial meningitis and admitted to Wad Medani Teaching Hospital, Gezira State, Sudan, between January 2017 and October 2022.ResultsIn total, 201 patients were included in the analysis. The mean age of the participants was 44.1 ± 21.4 years, and 107 (53.2%) were male. Community-acquired bacterial meningitis accounted for 193 (96%) of the studied patients, and only 8 (4%) of the patients had healthcare-associated meningitis. Neuroimaging was utilized appropriately in 148 (73.6%) patients, blood cultures were not performed entirely, and lumbar puncture was seldom performed in 1 (0.5%) patient. Corticosteroids were appropriately administered to 65 (32.3%) patients, and antibiotics were administered appropriately to only 5 (2.5%) patients. Ceftriaxone 185 (76.1%) was the most frequently utilized antibiotic, followed by vancomycin 23 (9.5%). In terms of overall adherence, this study demonstrated that the IDSA guidelines were not followed at all in the treatment of patients with suspected bacterial meningitis.ConclusionThe results of this study contradict the IDSA guidelines for the standard of care for bacterial meningitis. Antibiotic regimens are often incorrect, corticosteroids are administered appropriately in approximately one-third of patients, and neuroimaging is reasonably utilized. This study raises attention to several important issues regarding the diagnosis of bacterial meningitis, including the lack of confirming microbiological tests and the reliance of the diagnosis primarily on CT and clinical examination.

Management of Adults With Bacterial Meningitis in the Emergency Department.

The Leicester Royal Infirmary Emergency Department is one of the largest single-site Emergency Departments in the UK. We evaluated the department's management of bacterial meningitis. The current national guideline recommends that all patients presenting with suspected bacterial meningitis receive antibiotics within one hour. A survey of 100 clinicians (Consultants, Registrars, House Officers, and Advanced Clinical Practitioners) working in the Emergency Department was performed to determine the awareness of the guidelines and a retrospective examination of case notes for patients who presented at the Leicester Royal Infirmary Emergency Department with suspected meningitis was carried out between May 1, 2022, and May 1, 2023. A random sample of 30 patients was drawn from the department's database of 190 patients, identified through discharge coding summaries. Nine (25%) of the prescribers knew of the guidelines for managing meningitis, and six (16.7%) had utilised the hospital guidelines. Thirty-three (91.7%) prescribers acknowledged the importance of administering steroids to patients suspected of having bacterial meningitis (excluding those displaying signs of meningococcal sepsis, such as a rash). However, only seven (23%) of patients received this treatment. Additionally, only one (3.3%) patient was documented as having received a dose within the first hour of presentation. The timely diagnosis and administration of appropriate antibiotic therapy are pivotal elements in managing bacterial meningitis. As a result, we designed a checklist to facilitate the effective management of meningitis within the department by increasing awareness of the guidelines and making the critical principles of suspected meningitis management more accessible.

Реамберин у комплексі оптимізації та диференціації стратегії інтенсивної терапії вторинних гнійних менінгоенцефалітів

Стаття присвячена питанням покращання діагностики, застосування методик оцінки тяжкості стану хворих при надходженні у відділення інтенсивної терапії, у динаміці спостереження за ними, оптимізації інтенсивної терапії (ІТ) вторинного гнійного менінгоенцефаліту (ВГМЕ). Загальна схема відбору пацієнтів, їх рандомізації, включення в дослідження й аналіз можуть бути подані в такий спосіб. Пацієнти з підтвердженим ВГМЕ методом рандомізації з урахуванням тяжкості стану та варіанту ІТ були розподілені на 2 групи. У I групу увійшли 22 пацієнти, котрим проводилася базисна ІТ із позицій доказової медицини відповідно до міжнародних рекомендацій Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septiс shock 2012, що доповнювалася включенням дексаметазону. У II групу увійшов 21 пацієнт, у яких ІТ, що проводилась у I групі, доповнювалась в/в введенням розчину реамберин. На початку дослідження не виявлено вірогідних відмінностей між групами за статтю, віком, локалізацією септичного вогнища, частотою реєстрації 4 ознак синдрому системної запальної відповіді, позитивних результатів бактеріологічних посівів ліквору та матеріалів із первинного вогнища, тобто вибірки були порівняними за цими ознаками. У цей же час серед пацієнтів II групи було в 2,8 раза більше хворих із рівнем свідомості «сопор» або «кома I ступеня» (76,2 % проти 27,2 %; р < 0,001). Несприятливий прогноз (центральний перфузійний тиск < 50 мм рт.ст.) при надходженні до стаціонару мали 22,7 % хворих із I групи і 28,6 % — із II (р > 0,60). Незважаючи на початково більш тяжкий стан хворих із ВГМЕ в II групі, додавання до базисної терапії в/в введення розчину реамберин сприяло тому, що санація ліквору в II групі проходила більш плавно, без вторинного сплеску цитозу, характерного для I групи на 5-ту добу дослідження. Установлено, що в I групі С-реактивний білок у лікворі зникав до 3-ї доби дослідження, з’являвся на 5-ту добу і був відсутнім до 7-ї доби дослідження. У II групі наявність С-реактивного білка було зафіксовано лише на початку і 1-шу добу дослідження, що свідчить про більш стійкий характер відновлення функціонального стану гематоенцефалічного бар’єра в II групі, без вторинного (повторного) його прориву. Оцінка ефективності ІТ на 28-му добу дослідження показала, що відмічалось зменшення когнітивних дисфункцій у I групі на 28,4 %, у II — на 37,7 %; органних дисфункцій у I групі — з 76,3 до 43,8 %; у II — з 88,7 до 36,9 %. Показники істинної летальності становили 27,27 і 23,81 % (р > 0,90) відповідно. Зниження прогнозованої летальності в I групі становило 4,73 %, у II — 16,19 %.

Pathophysiology and Management of Bacterial Meningitis in Pediatrics

Bacterial meningitis in children and infants is correlated with substantial morbidity and mortality. Bacterial meningitis is one of the most frequent central nervous system infections, which is prevalent in low-income countries. There are three types of neonatal meningitis such as early-onset meningitis (from 0–6 days); late-onset meningitis (from 7–29 days) and extremely late-onset meningitis (from 30–90 days). The intense inflammation within the subarachnoid space noted in lumbar cerebrospinal fluid, and the resulting neurological damage, are not the direct result of the pathogenic bacteria but rather of activation of the host’s inflammatory pathways by the microorganisms or their products. All children who are suspected of having meningitis should have their cerebrospinal fluid examined unless lumbar puncture is contraindicated. The critical elements of managing pediatric meningitis involve prompt initiation of therapy, use of the appropriate antimicrobial with correct dosing and duration, attention to expected complications, and appropriate follow-up. In neonates, the primary empiric regimen used conventionally has been ampicillin and gentamycin. For infants whose cerebrospinal fluid is suspicious for bacterial meningitis, ampicillin (300 mg/kg per day divided every 6 hrs) and cefotaxime (200 to 300 mg/kg per day divided every 6 hrs) is appropriate.

Risk Factors and Management of Bacterial Meningitis

Meningitis is the infection of the spinal cord and brain. Bacterial meningitis is a great public health concern, especially in immunocompromised patients and children, particularly in underdeveloped counties. There are various types of bacterial meningitis (pneumococcal, meningococcal, listeria monocytogenes, neonatal, Hemophilus) having different rates of incidences and etiological agents. It occurs when bacteria get into the bloodstream from the nose, sinuses and ear. s. Infants and children are more susceptible to bacterial meningitis; similarly, alcoholics, smokers, malnutrient people, people with HIV and TB are at higher risks of this infection; all these factors must be taken into account to determine its severity. The diagnosis has critical importance and is considered one of the most urgent microbial medical emergencies. The use of vaccines is essential to eradicate this disease from the globe. This article highlights the risk factors, current diagnosis, treatment options and management plans in terms of bacterial meningitis.

16 Variability in lumbar punctures and neuroimaging in infants less than 90 days with acute bacterial meningitis at a provincial children’s hospital in Canada

Abstract Background Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization. Objectives The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH). Design/Methods A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap. Results Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%). Conclusion This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.

1395. Comparison of Four Recommendations Guiding the Use of Neuroimaging in the Management of Bacterial Meningitis

BackgroundCurrently multiple sets of recommendations exist to guide the use of cranial imaging before lumbar puncture in adults with suspected meningitis. We aimed to compare the utility of the four main guidelines [Infectious Diseases Society of America (IDSA), European Society for Clinical Microbiology and Infectious Diseases (ESCMID), UK, and Swedish guidelines] in detecting major head CT scan findings that eventually impacted clinical management in adults with community-acquired bacterial meningitis.MethodsA retrospective observational study of 111 adults (age > 17 years) with community-acquired bacterial meningitis admitted to 10 tertiary care hospitals in Houston TX, between December 2004 and March 2016. Major and minor CT findings were stratified based on their inclusion status within the four separate guidelines.ResultsA total of 38 (34%) patients had minor head CT scans (small ischemic white matter changes, lacunar strokes) and 17 (15%) patients had major CT findings (hydrocephalus, subarachnoid hemorrhage or interventricular hemorrhage, cerebral edema, pneumocephalus, ventriculomegaly, septic embolus, hindbrain herniation, and temporal lobe encephalitis). Of those 17 with major CT findings, 6 patients had a change in clinical management [External Ventricular Drainage (EVD) placement] as a direct result of their CT findings. The IDSA set of guidelines was the only one that included all of the major CT scan findings and all the cases in which the findings of a brain CT resulted in a change in management (EVD placement).ConclusionThe IDSA was the most inclusive guideline in regards to (1) indications for cranial imaging that would have detected all major abnormal brain CT findings and 2) including cranial imaging that resulted in significant changes in clinical management in adults with community-acquired bacterial meningitis. Disclosures All authors: No reported disclosures.

Rapid diagnosis of bacterial meningitis by nanopore 16S amplicon sequencing: A pilot study

Early administration of antibiotics is crucial in the management of bacterial meningitis. Rapid pathogen identification helps to make a definite diagnosis of bacterial meningitis and enables tailored antibiotic treatment. We investigated if the 16S amplicon sequencing performed by MinION, a nanopore sequencer, was capable of rapid pathogen identification in bacterial meningitis. Six retrospective cases of confirmed bacterial meningitis and two prospective cases were included. The initial cerebrospinal fluid (CSF) samples of these patients were used for the experiments. DNA was extracted from the CSF, and PCR was performed on the 16S ribosomal DNA (16S rDNA). Sequencing libraries were prepared using the PCR products, and MinION sequencing was performed for up to 3 h. The reads were aligned to the bacterial database, and the results were compared to the conventional culture studies. Pathogenic bacteria were successfully detected from the CSF by 16S sequencing in all retrospective cases. 16S amplicon sequencing was more sensitive than conventional diagnostic tests and worked properly even in antibiotics-treated samples. MinION sequencing significantly reduced the turnaround time, and even 10 min of sequencing was sufficient for pathogen detection in certain cases. Protocol adjustment could further increase the sensitivity and reduce the turnaround time for MinION sequencing. Finally, the prospective application of MinION 16S sequencing was successful. Nanopore 16S amplicon sequencing is capable of rapid bacterial identification from the CSF of the bacterial meningitis patients. It may have many advantages over conventional diagnostic tests and should therefore be applied in a larger number of patients in the future.

Proteomic profiling to identify markers of bacterial meningitis

Bacterial meningitis is usually fatal without treatment and prompt and accurate diagnosis coupled with the timely administration of parenteral antibiotics are necessary in order to save lives. Despite the availability of highly effective antibiotics, the complications from bacterial meningitis (such as deafness, hydrocephalus, seizures and cerebral palsy) remain high. In areas with a high incidence of human immunodeficiency virus infection, Streptococcus pneumoniae is the commonest cause of bacterial meningitis. The diagnosis of bacterial meningitis can sometimes be delayed whilst samples are analysed in a laboratory using traditional methods of microscopy and antigen testing. We used cutting-edge high definition and quantitative mass spectrometry to identify specific protein signatures in cerebrospinal fluid associated with Streptococcus pneumoniae infection which could lead to the development of assays or point-of-care devices to improve the speed and accuracy of diagnosis, and consequently to enhance the prognosis of adults and children with bacterial meningitis. A range of samples (cases and controls, n=12) from Malawian children has been analysed. Our data indicate some clear trends, and confirm that quantitative proteomics analysis will be successful in generating a comprehensive protein list from which markers might be nominated. We identified a total of 519 proteins in data dependent discovery proteomics and obtained quantitative data for 161 proteins using data independent Hi3 quantification. Using Progenesis LCMS we obtained a list of 202 potential candidates using data dependent acquisition approach and 109 using data independent acquisition, 82 proteins being common to both workflows. The protein profiles clearly differentiated cases and controls and have the potential to inform diagnosis and management of bacterial meningitis, especially in the developing world where the disease burden and mortality is greatest.

G430(P) Research and development approval timelines for an NIHR portfolio adopted multicentre observational study in England and Wales

Over the last 15 years the processes for obtaining research and development (R&D) approval for conducting multicentre medical research in England have undergone some changes. The introduction of participant identification...

Diagnosis and management of bacterial meningitis in the paediatric population: a review.

Paediatric bacterial meningitis is a neurological emergency which, despite advances in medical management, still has a significant morbidity and mortality. Over recent decades new vaccines have led to a change in epidemiology of the disease; however, it remains a condition that requires a high index of suspicion, prompt diagnosis, and early management in the emergency department. New laboratory techniques and clinical tools are aiding the diagnosis of bacterial meningitis, yet some controversies still exist in its management. This paper outlines the changing epidemiology of the disease, current diagnostic techniques as well as controversies and advances in the management of bacterial meningitis in the paediatric population.

6．成人の細菌性髄膜炎の診断と治療―日本のガイドラインから

6．成人の細菌性髄膜炎の診断と治療―日本のガイドラインから

Clinical Practice Guidelines for the Management of Bacterial Meningitis in Adults in Korea

Clinical Practice Guidelines for the Management of Bacterial Meningitis in Adults in Korea

Signs, symptoms and management of bacterial meningitis

This article describes the common causes of bacterial meningitis, signs and symptoms, and management. It summarises the 2010 guideline on bacterial meningitis and meningococcal septicaemia produced by the National Institute for Health and Clinical Excellence.

Signs, symptoms and management of bacterial meningitis

Signs, symptoms and management of bacterial meningitis

Initial Evaluation and Management of Bacterial Meningitis in an Emergent Setting

Bacterial meningitis is a severe infection involving the meninges, which surround and protect the brain and spinal cord. The infection leads to a significant host response and inflammation in this area. Potential consequences of this disease include hearing loss, seizures, hydrocephalus, permanent neurological deficits, coma, or death. Timely and effective therapy to treat meningitis is integral to the success of therapy and the prevention of neurological sequalae. The purpose of this review is to discuss the rapid identification and management of bacterial meningitis.

Therapeutic Management of Bacterial Meningitis in Children: A Systematic Review and Comparison of Published Guidelines from a European Perspective

Bacterial meningitis is an infectious disease emergency that can cause substantial morbidity and mortality. We compared the most recent international guidelines and recommendations on bacterial meningitis management in infants and children in developed countries, in terms of initial management approach, empirical antimicrobial therapy, timing, dosages, and duration of antimicrobial therapy, and possible adjunctive treatment with dexamethasone. Secondly, epidemiological data on bacterial resistance in several European countries were analyzed and discussed in relation to the therapies currently recommendedfor bacterial meningitis.The comparative analysis of the selected guidelines highlighted significant differences in the therapeutic management of bacterial meningitis. Differences among guide-lines have important consequences for daily practice. An agreed protocol for early, evidence-based, and effective therapeutic management of bacterial meningitis is essential for the best outcome. Further studies and expert consensus are required to establish the best management of bacterial meningitis in the European setting based on the most recent epidemiological data on resistance rates.

The Evaluation and Management of Bacterial Meningitis

Bacterial meningitis is a serious neurologic illness with significant morbidity and mortality if not recognized and treated promptly and appropriately. The presentation and management are influenced by host factors and the pathogenic organism; the purpose of this review is to highlight those differences and to survey the literature on current practices and emerging developments in evaluation and management. Clinicians must have a high index of suspicion for bacterial meningitis. The classic symptoms of bacterial meningitis are fever, neck stiffness, altered mental status, and headache. Certain patient populations, such as the young and the immunocompromised, may have a blunted presentation, and for these patients, clinicians must have an especially low threshold for obtaining a lumbar puncture. When bacterial meningitis is suspected, antibiotic therapy should be initiated as soon as possible because early treatment is associated with a better outcome. In addition, the use of the corticosteroid dexamethasone has been shown to be helpful as an adjuvant therapy in specific clinical situations. New adjuvant therapies are being developed to lower the high rate of complications that currently occur in patients with bacterial meningitis. Recent studies have altered the evaluation and management of bacterial meningitis. In addition, they have elucidated the mechanisms through which bacterial meningitis causes complications and have identified new targets for treatment.

The Pharmacokinetics and Pharmacodynamics of Meropenem in the Cerebrospinal Fluid of Neurosurgical Patients

This study examined the pharmacokinetics and pharmacodynamics of meropenem in cerebrospinal fluid (CSF). Meropenem (0.5 g every 8 h) was administered by 0.5-h infusion to six neurosurgical patients. Lumbar CSF and venous blood samples were obtained at 0.5-16 h after the start of the first infusion. Drug concentrations in the CSF and plasma were analyzed pharmacokinetically and used for a Monte Carlo simulation with the minimum inhibitory concentration (MIC) data of clinical isolates in Japan. Meropenem penetrated into the CSF with the area under the drug concentration-time curve ratio of 0.10 ± 0.03 (mean ± SD) and the repeated infusions caused the drug concentration in the CSF to accumulate slightly. Against Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and Escherichia coli isolates, 0.5 g q8h achieved a >90% probability of pharmacodynamic target (50% of the time above MIC) attainment, and 1 g q8h was needed for a >90% probability of target (100% of the time above MIC) attainment. However, against Pseudomonas aeruginosa, 2 g q8h achieved a lower probability of target attainment. These results should help us to better elucidate the pharmacokinetics of meropenem in the cerebrospinal space while also helping us to choose the appropriate drug dosages for the management of bacterial meningitis.

Klebsiella pneumoniae meningitis in a 38-year-old Chinese traveller with impaired glucose tolerance: A new emerging syndrome?

Early diagnosis and appropriate empirical treatment of bacterial meningitis reduce morbidity and mortality. Prevalence rates of different causative pathogens associated with bacterial meningitis can depend on age, the underlying medical condition, way of infection and geographical distribution. Klebsiella pneumoniae represents an infrequent cause of community-acquired meningitis in South-East Asia and North-East Asia, where it accounts for 20% of all bacterial meningitis, frequently associated with septic metastatic complications. We describe a case of K. pneumoniae meningitis, diplopia and chemosis in a recently immigrated patient with impaired glucose tolerance. The reason for the high prevalence of metastatic septic infections caused by K. pneumoniae in Taiwan and South-East Asia remains unclear: high prevalence in this area of serotype K1 and K2 and the expression of a novel locus called magA conferring to bacterium an elevated phagocytosis resistance and an active proliferation ability have been suggested. A high degree of suspicion for this etiology must be taken into account in immigrants from China and Taiwan. Due to a very high lethality, guidelines on empiric treatment should be considered in the management of bacterial meningitis, with the patients geographical origin and the clinical syndrome (meningitis and endophtalmitis) as potential risk factors for K. pneumoniae infection.