TY - JOUR
T1 - Impact of an evidence-based guideline on the management of community-acquired bacterial meningitis
T2 - a prospective cohort study
AU - Costerus, J M
AU - Brouwer, M C
AU - Bijlsma, M W
AU - Tanck, M W
AU - van der Ende, A
AU - van de Beek, D
N1 - Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PY - 2016/11
Y1 - 2016/11
N2 - OBJECTIVES: To study the impact of an evidence-based guideline on the management of community-acquired bacterial meningitis.METHODS: We performed an interrupted time series analysis in a prospective nationwide cohort study from 2006 to 2015. The guideline stresses the importance of cranial imaging before lumbar puncture (LP) in selected patients based on clinical criteria, and early treatment with amoxicillin and a third-generation cephalosporin for adults with suspected community-acquired bacterial meningitis. The guideline was published in April 2013.RESULTS: We included 1326 episodes before and 210 episodes after guideline introduction. Cranial imaging was performed before LP in 497 (84%) of 591 episodes with clinical criteria warranting computed tomography (CT). The guideline did not improve this (increase of 2%; 95% confidence interval (CI), -15 to 19). Without these criteria, imaging before LP occurred in 606 (67%) of 900 episodes, also without effect of the guideline (increase of 1%; 95% CI, -25 to 28). The estimate of effect of the guideline for treatment with the recommended antibiotic regimen was an increase of 19.5% (95% CI, 13.5 to 25.5), and there was a trend towards more frequent initiation of treatment before CT. There was no association between delay in antibiotic treatment due to imaging before LP and unfavourable outcome (odds ratio, 1.14; 95% CI 0.86 to 1.52).CONCLUSIONS: Cranial imaging is performed before LP in the majority of patients with bacterial meningitis, irrespective of guideline indications. The guideline introduction was associated with a trend towards early initiation of treatment before imaging and with increased adherence to antibiotic policy.
AB - OBJECTIVES: To study the impact of an evidence-based guideline on the management of community-acquired bacterial meningitis.METHODS: We performed an interrupted time series analysis in a prospective nationwide cohort study from 2006 to 2015. The guideline stresses the importance of cranial imaging before lumbar puncture (LP) in selected patients based on clinical criteria, and early treatment with amoxicillin and a third-generation cephalosporin for adults with suspected community-acquired bacterial meningitis. The guideline was published in April 2013.RESULTS: We included 1326 episodes before and 210 episodes after guideline introduction. Cranial imaging was performed before LP in 497 (84%) of 591 episodes with clinical criteria warranting computed tomography (CT). The guideline did not improve this (increase of 2%; 95% confidence interval (CI), -15 to 19). Without these criteria, imaging before LP occurred in 606 (67%) of 900 episodes, also without effect of the guideline (increase of 1%; 95% CI, -25 to 28). The estimate of effect of the guideline for treatment with the recommended antibiotic regimen was an increase of 19.5% (95% CI, 13.5 to 25.5), and there was a trend towards more frequent initiation of treatment before CT. There was no association between delay in antibiotic treatment due to imaging before LP and unfavourable outcome (odds ratio, 1.14; 95% CI 0.86 to 1.52).CONCLUSIONS: Cranial imaging is performed before LP in the majority of patients with bacterial meningitis, irrespective of guideline indications. The guideline introduction was associated with a trend towards early initiation of treatment before imaging and with increased adherence to antibiotic policy.
KW - Adolescent
KW - Adult
KW - Aged
KW - Amoxicillin/administration & dosage
KW - Brain/diagnostic imaging
KW - Cephalosporins/administration & dosage
KW - Community-Acquired Infections/diagnostic imaging
KW - Disease Management
KW - Evidence-Based Medicine
KW - Humans
KW - Interrupted Time Series Analysis
KW - Meningitis, Bacterial/diagnostic imaging
KW - Middle Aged
KW - Netherlands
KW - Practice Guidelines as Topic
KW - Prospective Studies
KW - Spinal Puncture/statistics & numerical data
KW - Tomography, X-Ray Computed/methods
KW - Young Adult
U2 - 10.1016/j.cmi.2016.07.026
DO - 10.1016/j.cmi.2016.07.026
M3 - Article
C2 - 27484018
VL - 22
SP - 928
EP - 933
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
SN - 1198-743X
IS - 11
ER -