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075 Meningitis management audit at a single centre: further support for culture-independent techniques in diagnosing meningitis
  1. Simon Williams1,
  2. Ghaniah Hassan-Smith2
  1. 1University of Birmingham Medical School
  2. 2Queen Elizabeth Hospital Birmingham

Abstract

Objective Rapid identification of meningitis and initiation of rational treatment is critically important. We reviewed whether our management was consistent with recent recommendations, for patients treated August 2015-July 2018.

Methods Patients aged ≥16 coded as having meningitis/meningoencephalitis/specific meningitides (total codes=27) at QEHB over this period (n=497) were identified by informatics and data analysed using electronic records. Specific patient groups were analysed including post-neurosurgical and community-acquired meningitis.

Results 183 patients met the inclusion criteria, for community-acquired meningitis (n=118) or post-neurosurgery (n=65). Within the A&E subgroup (n=92), 80% received neuroimaging pre-LP despite 78% not having contraindication to LP. Median time to LP was 19hours (IQR:11.0–31.0); none performed within 1hour. Antibiotics were administered prior to LP in 72% cases. No neurosurgical patients had meningococcal/pneumococcal serum or CSF PCR sent. Serum PCR was sent in 11% of community-acquired meningitis patients - 23% were positive. CSF PCR was sent in 28% - 22% were positive. None of these cases had positive CSF culture.

Conclusions Despite BIA recommendations, time-to-LP was delayed and culture-independent techniques such as serum/CSF PCR for bacterial pathogens were under-utilised, despite out-performing CSF culture. The emergence of novel culture-independent methods, including targeted point-of-care and unbiased-metagenomic sequencing, are likely to become increasingly relevant.

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