Adult Bacterial Meningitis: Earlier Treatment and Improved Outcome Following Guideline Revision Promoting Prompt Lumbar Puncture

Abstract

The deletion of impaired mental status as contraindication for prompt LP and LP without prior CT scan are associated with significantly earlier treatment and a favorable outcome. A revision of current international guidelines should be considered.

Simultaneous Detection of Bacterial Meningitis in Suspected Cases of Meningitis in Children Using PCR Assay, In Taif, Saudi Arabia

“…However, these approaches may have some limitations with regard to the relatively low rapidity and sensitivity and a delay in the diagnosis and treatment of BM could lead to irreversible brain damage. It was confirmed by a recent study, which showed that mortality was increased by 13% for every hour without antibiotics [10].…”

Acute Bacterial Meningitis Complicated by Brain Herniation Shortly after Lumbar Puncture: A Case Report

“…Most of the case reports and case series of brain herniation secondary to meningitis showed change in the level of consciousness before LP (Joffe, 2007). The clinical contraindications of LP are changing levels of consciousness, fixed dilated pupils, fixed eye deviation, posturing, respiratory changes, papilledema, recent seizure or hypertension with bradycardia (Joffe, 2007;Swanson, 2015;Glimaker, 2015;Auburtin et al, 2006). We conclude that the clinical signs and symptoms are the most important indicators in identifying the risk of herniation and deciding when to delay LP.…”

“…There is clear evidence that the brain CT scan before LP leads to a delay in antibiotic administration (Nagra, 2011;Glimaker et al, 2015). The delaying of antibiotic administration for more than 3 hours leads to a poor clinical outcome (Glimaker et al, 2015;Auburtin et al, 2006). Most of the case reports and case series of brain herniation secondary to meningitis showed change in the level of consciousness before LP (Joffe, 2007).…”

“…There is no clear guideline about the indications of CT before LP in pediatric; there are different protocols for adults varying in accordance with the conservation (April, Long, & Koyfman, 2017;Glimåker, Sjölin, Åkesson, & Naucler, 2017). There is clear evidence that CT scan before LP leads to a delay in antibiotic administration (Nagra, Wee, Short, & Banerjee, 2011;Glimaker, Johansson, Grindborg, Bottai, Lindquist, & Sjolin, 2015). The delaying of antibiotic administration by more than 3 hours leads to a poor clinical outcome (Glimaker et al, 2015;Auburtin et al, 2006).…”

“…There is clear evidence that CT scan before LP leads to a delay in antibiotic administration (Nagra, Wee, Short, & Banerjee, 2011;Glimaker, Johansson, Grindborg, Bottai, Lindquist, & Sjolin, 2015). The delaying of antibiotic administration by more than 3 hours leads to a poor clinical outcome (Glimaker et al, 2015;Auburtin et al, 2006).…”