ObjectivesTo assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.DesignRetrospective cohort study.Setting64 UK and Irish ...hospitals.Participants1471 adults with community-acquired meningitis of any aetiology in 2017.ResultsNone of the audit standards, from the 2016 UK Joint Specialists Societies guideline on diagnosis and management of meningitis, were met in all cases. With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases. 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within 1 hour, 26% within 8 hours. 28% had bacterial molecular diagnostic tests on cerebrospinal fluid. Median time to first dose of antibiotics was 3.2 hours (IQR 1.3–9.2). 80% received empirical parenteral cephalosporins. 55% ≥60 years and 31% of immunocompromised patients received anti-Listeria antibiotics. 21% received steroids. Of the 1471 patients, 20% had confirmed bacterial meningitis. Among those with bacterial meningitis, pneumococcal aetiology, admission to intensive care and initial Glasgow Coma Scale Score less than 14 were associated with in-hospital mortality (adjusted OR (aOR) 2.08, 95% CI 0.96 to 4.48; aOR 4.28, 95% CI 1.81 to 10.1; aOR 2.90, 95% CI 1.26 to 6.71, respectively). Dexamethasone therapy was weakly associated with a reduction in mortality in both those with proven bacterial meningitis (aOR 0.57, 95% CI 0.28 to 1.17) and with pneumococcal meningitis (aOR 0.47, 95% CI 0.20 to 1.10).ConclusionThis study demonstrates that clinical care for patients with meningitis in the UK is not in line with current evidence-based national guidelines. Diagnostics and therapeutics should be targeted for quality improvement strategies. Work should be done to improve the impact of guidelines, understand why they are not followed and, once published, ensure they translate into changed practice.
Point-of-care testing (POCT) for influenza viruses is being used increasingly in NHS hospitals. In the 2017/18 influenza season, NHS Greater Glasgow and Clyde implemented the Cepheid GeneXpert System ...for the detection of influenza A, B and respiratory syncytial virus in 7 wards across 5 hospital sites. To evaluate the impact of influenza POCT in Glasgow Royal Infirmary during the 2017/18 influenza season, we retrospectively compared data from 150 influenza A infected patients. We analysed data from 100 patients who were diagnosed using a laboratory based in-house respiratory PCR assay (50 patients from 2016/17 and 50 patients from the 2017/18 season) and 50 patients who were diagnosed using POCT in the 2017/18 season. The aim of the study was to investigate whether POCT impacted patient management and outcome. General linear models were used to test for an association between POCT and a number of outcomes, whilst accounting for host factors. These outcomes included: (1) time from review to influenza result (2) admission status (3) length of hospital stay (4) patient outcome (5) duration of antibiotics (6) antiviral treatment (7) patient isolation and (8) the number of duplicate influenza tests performed. In addition to investigating the impact of POCT, we used this opportunity to explore additional factors that may affect the outcomes of patients infected with influenza A, including: age, sex, imaging results and underlying risk factors.
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