Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)

Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Amy Robinson [verfasserIn] Kamaljit Khalsa [verfasserIn] Arjun Chandna [verfasserIn] John Bowen [verfasserIn] Viva Levee [verfasserIn] Jan Coebergh [verfasserIn] Tom Solomon [verfasserIn] Clive Graham [verfasserIn] David Turner [verfasserIn] Robert Tilley [verfasserIn] Tim Jones [verfasserIn] Susan Hopkins [verfasserIn] Matthew Stevens [verfasserIn] Daniel White [verfasserIn] Celestine Eshiwe [verfasserIn] Anna Goodman [verfasserIn] Ramandeep Singh [verfasserIn] Robert S Heyderman [verfasserIn] Nicholas Davies [verfasserIn] Joseph Thompson [verfasserIn] Ed Moran [verfasserIn] Sarah Kelly [verfasserIn] Martin Williams [verfasserIn] Rhea O’Regan [verfasserIn] Simon Tiberi [verfasserIn] Jonathan Lambourne [verfasserIn] Naomi Bulteel [verfasserIn] Susan Larkin [verfasserIn] Ruth McEwen [verfasserIn] Hassan Paraiso [verfasserIn] Aarti Shah [verfasserIn] Martin Wiselka [verfasserIn] Sylviane Defres [verfasserIn] Ernest Mutengesa [verfasserIn] Maria Krutikov [verfasserIn] Ruth Owen [verfasserIn] David Griffith [verfasserIn] David Harvey [verfasserIn] Trupti Patel [verfasserIn] Brendan Davies [verfasserIn] Emma Mclean [verfasserIn] Joanna Allen [verfasserIn] Ali Khan [verfasserIn] Alastair Miller [verfasserIn] Ashutosh Deshpande [verfasserIn] Christopher Green [verfasserIn] Lewis Jones [verfasserIn] Mark Melzer [verfasserIn] Fiona McGill [verfasserIn] Amanda Fife [verfasserIn] Nimal Wickramasinghe [verfasserIn] Stephanie Harris [verfasserIn] Ewan Hunter [verfasserIn] Jayne Ellis [verfasserIn] Benedict Rogers [verfasserIn] Imogen Fordham [verfasserIn] Elen Vink [verfasserIn] Victoria Ward [verfasserIn] Anna Smith [verfasserIn] Andrew Rosser [verfasserIn] Alison Muir [verfasserIn] Ken Woodhouse [verfasserIn] John Shone [verfasserIn] Iain Crossingham [verfasserIn] Ryan Jayesinghe [verfasserIn] Eavan Muldoon [verfasserIn] Avneet Shahi [verfasserIn] Terry John Evans [verfasserIn] Jeremy Wong [verfasserIn] Eloisa MacLachlan [verfasserIn] Amy Chue [verfasserIn] Karishma Gokani [verfasserIn] Katherine Ajdukiewicz [verfasserIn] Lucinda Barrett [verfasserIn] Frances Edwards [verfasserIn] Adam Usher [verfasserIn] Mairi McLeod [verfasserIn] Su su Htwe [verfasserIn] Grace Duane [verfasserIn] Nicholas Wong [verfasserIn] Jennifer Poyner [verfasserIn] Jenni Crane [verfasserIn] Ollie Lloyd [verfasserIn] Emma Chisholm [verfasserIn] Ildiko Kustos [verfasserIn] Sam Sutton [verfasserIn] M. Estee Torok [verfasserIn] Isobel Ramsay [verfasserIn] Monica Ivan [verfasserIn] Joshua York [verfasserIn] Jennifer Ansett [verfasserIn] Maithili Varadarajan [verfasserIn] Priya Sekhon [verfasserIn] James Cruise [verfasserIn] Shivani Kanabar [verfasserIn] Mirella Ling [verfasserIn] Charlotte Milne [verfasserIn] Jayanta Sarma [verfasserIn] Aline Wilson [verfasserIn] Lynn Urquhart [verfasserIn] Sahar Eldirdiri [verfasserIn] Leila White [verfasserIn] Jody Aberdein [verfasserIn] Phillip Simpson [verfasserIn] Hnin Hay Mar [verfasserIn] Keying Tan [verfasserIn] Eint Shwe Zin thein [verfasserIn] Mahmoud Aziz [verfasserIn] Anthony Cadwgan [verfasserIn] Natasha Weston [verfasserIn] Salman Zeb [verfasserIn] Angela Houston [verfasserIn] Louise Wootton [verfasserIn] Iona Willingham [verfasserIn] Aimee Johnson [verfasserIn] Ashley Horsley [verfasserIn] Eamonn Trainor [verfasserIn] Olivier Gaillemin [verfasserIn] Nicholas J Norton [verfasserIn] Katie Cheung [verfasserIn] Megan Duxbury [verfasserIn] Emilie Bellhouse [verfasserIn] Helena Brezovjakova [verfasserIn] Kanitkar Tanmay [verfasserIn] Alexsander Dawidziuk [verfasserIn] Razan Saman [verfasserIn] Hugh Adler [verfasserIn] Elshadai Ejere [verfasserIn] Yiwen Soo [verfasserIn] Wendy Beadles [verfasserIn] Heather Sturgeon [verfasserIn] Brodie Cameron [verfasserIn] David Chadwick Ben Tomlinson [verfasserIn] Claire McGoldrick [verfasserIn] Katie McDowell [verfasserIn] Mpho Molosiwa [verfasserIn] Katherine FlackAdrian Kennedy [verfasserIn] Phoebe Cross [verfasserIn] Fay Perry [verfasserIn] Vithusha Inpadhas [verfasserIn] Sarathy Selvam [verfasserIn] Vhairi Bateman [verfasserIn] Henry Wu [verfasserIn] Monika Pasztor [verfasserIn] Ajanthiha Karunakaran [verfasserIn] Basma Soliman [verfasserIn] Andrew Blanshard [verfasserIn] Harish Reddy [verfasserIn] Helen Chesterfield [verfasserIn] Ben Schroeder [verfasserIn] Tee Keat Teoh [verfasserIn] Sathyavani Subbarao [verfasserIn] Caryn RosmarinLucy Bell [verfasserIn] Emma McGuire [verfasserIn] Robert Serafino [verfasserIn] Ishaan Bhide [verfasserIn] Karanjeet Sagoo [verfasserIn] Indran Balakrishnan [verfasserIn] Kajal Patel [verfasserIn] Barzo Faris [verfasserIn] Graeme Calver [verfasserIn] Ricky Singh [verfasserIn] Hazel Sanghvi [verfasserIn] Mohamed Eltayeb [verfasserIn] Rathur Haris [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2022

Übergeordnetes Werk:	In: BMJ Open - BMJ Publishing Group, 2011, 12(2022), 7
Übergeordnetes Werk:	volume:12 ; year:2022 ; number:7

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1136/bmjopen-2022-062698

Katalog-ID:	DOAJ041417747

Internformat


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100	0		\|a Amy Robinson \|e verfasserin \|4 aut
245	1	0	\|a Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
264		1	\|c 2022
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520			\|a Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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.
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912			\|a GBV_ILN_39
912			\|a GBV_ILN_40
912			\|a GBV_ILN_60
912			\|a GBV_ILN_62
912			\|a GBV_ILN_63
912			\|a GBV_ILN_65
912			\|a GBV_ILN_69
912			\|a GBV_ILN_73
912			\|a GBV_ILN_74
912			\|a GBV_ILN_95
912			\|a GBV_ILN_105
912			\|a GBV_ILN_110
912			\|a GBV_ILN_151
912			\|a GBV_ILN_161
912			\|a GBV_ILN_170
912			\|a GBV_ILN_206
912			\|a GBV_ILN_213
912			\|a GBV_ILN_230
912			\|a GBV_ILN_285
912			\|a GBV_ILN_293
912			\|a GBV_ILN_375
912			\|a GBV_ILN_602
912			\|a GBV_ILN_2014
912			\|a GBV_ILN_4012
912			\|a GBV_ILN_4037
912			\|a GBV_ILN_4112
912			\|a GBV_ILN_4125
912			\|a GBV_ILN_4126
912			\|a GBV_ILN_4249
912			\|a GBV_ILN_4305
912			\|a GBV_ILN_4306
912			\|a GBV_ILN_4307
912			\|a GBV_ILN_4313
912			\|a GBV_ILN_4322
912			\|a GBV_ILN_4323
912			\|a GBV_ILN_4324
912			\|a GBV_ILN_4325
912			\|a GBV_ILN_4338
912			\|a GBV_ILN_4367
912			\|a GBV_ILN_4700
951			\|a AR
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Indexfelder

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publishDate	2022
allfields	10.1136/bmjopen-2022-062698 doi (DE-627)DOAJ041417747 (DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4 DE-627 ger DE-627 rakwb eng Amy Robinson verfasserin aut Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Medicine R Kamaljit Khalsa verfasserin aut Arjun Chandna verfasserin aut John Bowen verfasserin aut Viva Levee verfasserin aut Jan Coebergh verfasserin aut Tom Solomon verfasserin aut Clive Graham verfasserin aut David Turner verfasserin aut Robert Tilley verfasserin aut Tim Jones verfasserin aut Susan Hopkins verfasserin aut Matthew Stevens verfasserin aut Daniel White verfasserin aut Celestine Eshiwe verfasserin aut Anna Goodman verfasserin aut Ramandeep Singh verfasserin aut Robert S Heyderman verfasserin aut Nicholas Davies verfasserin aut Joseph Thompson verfasserin aut Ed Moran verfasserin aut Sarah Kelly verfasserin aut Martin Williams verfasserin aut Rhea O’Regan verfasserin aut Simon Tiberi verfasserin aut Jonathan Lambourne verfasserin aut Naomi Bulteel verfasserin aut Susan Larkin verfasserin aut Ruth McEwen verfasserin aut Hassan Paraiso verfasserin aut Aarti Shah verfasserin aut Martin Wiselka verfasserin aut Sylviane Defres verfasserin aut Ernest Mutengesa verfasserin aut Maria Krutikov verfasserin aut Ruth Owen verfasserin aut David Griffith verfasserin aut David Harvey verfasserin aut Trupti Patel verfasserin aut Brendan Davies verfasserin aut Emma Mclean verfasserin aut Joanna Allen verfasserin aut Ali Khan verfasserin aut Alastair Miller verfasserin aut Ashutosh Deshpande verfasserin aut Christopher Green verfasserin aut Lewis Jones verfasserin aut Mark Melzer verfasserin aut Fiona McGill verfasserin aut Amanda Fife verfasserin aut Nimal Wickramasinghe verfasserin aut Stephanie Harris verfasserin aut Ewan Hunter verfasserin aut Jayne Ellis verfasserin aut Benedict Rogers verfasserin aut Imogen Fordham verfasserin aut Elen Vink verfasserin aut Victoria Ward verfasserin aut Anna Smith verfasserin aut Andrew Rosser verfasserin aut Alison Muir verfasserin aut Ken Woodhouse verfasserin aut John Shone verfasserin aut Iain Crossingham verfasserin aut Ryan Jayesinghe verfasserin aut Eavan Muldoon verfasserin aut Avneet Shahi verfasserin aut Terry John Evans verfasserin aut Jeremy Wong verfasserin aut Eloisa MacLachlan verfasserin aut Amy Chue verfasserin aut Karishma Gokani verfasserin aut Katherine Ajdukiewicz verfasserin aut Lucinda Barrett verfasserin aut Frances Edwards verfasserin aut Adam Usher verfasserin aut Mairi McLeod verfasserin aut Su su Htwe verfasserin aut Grace Duane verfasserin aut Nicholas Wong verfasserin aut Jennifer Poyner verfasserin aut Jenni Crane verfasserin aut Ollie Lloyd verfasserin aut Emma Chisholm verfasserin aut Ildiko Kustos verfasserin aut Sam Sutton verfasserin aut M. Estee Torok verfasserin aut Isobel Ramsay verfasserin aut Monica Ivan verfasserin aut Joshua York verfasserin aut Jennifer Ansett verfasserin aut Maithili Varadarajan verfasserin aut Priya Sekhon verfasserin aut James Cruise verfasserin aut Shivani Kanabar verfasserin aut Mirella Ling verfasserin aut Charlotte Milne verfasserin aut Jayanta Sarma verfasserin aut Aline Wilson verfasserin aut Lynn Urquhart verfasserin aut Sahar Eldirdiri verfasserin aut Leila White verfasserin aut Jody Aberdein verfasserin aut Phillip Simpson verfasserin aut Hnin Hay Mar verfasserin aut Keying Tan verfasserin aut Eint Shwe Zin thein verfasserin aut Mahmoud Aziz verfasserin aut Anthony Cadwgan verfasserin aut Natasha Weston verfasserin aut Salman Zeb verfasserin aut Angela Houston verfasserin aut Louise Wootton verfasserin aut Iona Willingham verfasserin aut Aimee Johnson verfasserin aut Ashley Horsley verfasserin aut Eamonn Trainor verfasserin aut Olivier Gaillemin verfasserin aut Nicholas J Norton verfasserin aut Katie Cheung verfasserin aut Megan Duxbury verfasserin aut Emilie Bellhouse verfasserin aut Helena Brezovjakova verfasserin aut Kanitkar Tanmay verfasserin aut Alexsander Dawidziuk verfasserin aut Razan Saman verfasserin aut Hugh Adler verfasserin aut Elshadai Ejere verfasserin aut Yiwen Soo verfasserin aut Wendy Beadles verfasserin aut Heather Sturgeon verfasserin aut Brodie Cameron verfasserin aut David Chadwick Ben Tomlinson verfasserin aut Claire McGoldrick verfasserin aut Katie McDowell verfasserin aut Mpho Molosiwa verfasserin aut Katherine FlackAdrian Kennedy verfasserin aut Phoebe Cross verfasserin aut Fay Perry verfasserin aut Vithusha Inpadhas verfasserin aut Sarathy Selvam verfasserin aut Vhairi Bateman verfasserin aut Henry Wu verfasserin aut Monika Pasztor verfasserin aut Ajanthiha Karunakaran verfasserin aut Basma Soliman verfasserin aut Andrew Blanshard verfasserin aut Harish Reddy verfasserin aut Helen Chesterfield verfasserin aut Ben Schroeder verfasserin aut Tee Keat Teoh verfasserin aut Sathyavani Subbarao verfasserin aut Caryn RosmarinLucy Bell verfasserin aut Emma McGuire verfasserin aut Robert Serafino verfasserin aut Ishaan Bhide verfasserin aut Karanjeet Sagoo verfasserin aut Indran Balakrishnan verfasserin aut Kajal Patel verfasserin aut Barzo Faris verfasserin aut Graeme Calver verfasserin aut Ricky Singh verfasserin aut Hazel Sanghvi verfasserin aut Mohamed Eltayeb verfasserin aut Rathur Haris verfasserin aut In BMJ Open BMJ Publishing Group, 2011 12(2022), 7 (DE-627)654747075 (DE-600)2599832-8 20446055 nnns volume:12 year:2022 number:7 https://doi.org/10.1136/bmjopen-2022-062698 kostenfrei https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 kostenfrei https://bmjopen.bmj.com/content/12/7/e062698.full kostenfrei https://doaj.org/toc/2044-6055 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 7
spelling	10.1136/bmjopen-2022-062698 doi (DE-627)DOAJ041417747 (DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4 DE-627 ger DE-627 rakwb eng Amy Robinson verfasserin aut Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Medicine R Kamaljit Khalsa verfasserin aut Arjun Chandna verfasserin aut John Bowen verfasserin aut Viva Levee verfasserin aut Jan Coebergh verfasserin aut Tom Solomon verfasserin aut Clive Graham verfasserin aut David Turner verfasserin aut Robert Tilley verfasserin aut Tim Jones verfasserin aut Susan Hopkins verfasserin aut Matthew Stevens verfasserin aut Daniel White verfasserin aut Celestine Eshiwe verfasserin aut Anna Goodman verfasserin aut Ramandeep Singh verfasserin aut Robert S Heyderman verfasserin aut Nicholas Davies verfasserin aut Joseph Thompson verfasserin aut Ed Moran verfasserin aut Sarah Kelly verfasserin aut Martin Williams verfasserin aut Rhea O’Regan verfasserin aut Simon Tiberi verfasserin aut Jonathan Lambourne verfasserin aut Naomi Bulteel verfasserin aut Susan Larkin verfasserin aut Ruth McEwen verfasserin aut Hassan Paraiso verfasserin aut Aarti Shah verfasserin aut Martin Wiselka verfasserin aut Sylviane Defres verfasserin aut Ernest Mutengesa verfasserin aut Maria Krutikov verfasserin aut Ruth Owen verfasserin aut David Griffith verfasserin aut David Harvey verfasserin aut Trupti Patel verfasserin aut Brendan Davies verfasserin aut Emma Mclean verfasserin aut Joanna Allen verfasserin aut Ali Khan verfasserin aut Alastair Miller verfasserin aut Ashutosh Deshpande verfasserin aut Christopher Green verfasserin aut Lewis Jones verfasserin aut Mark Melzer verfasserin aut Fiona McGill verfasserin aut Amanda Fife verfasserin aut Nimal Wickramasinghe verfasserin aut Stephanie Harris verfasserin aut Ewan Hunter verfasserin aut Jayne Ellis verfasserin aut Benedict Rogers verfasserin aut Imogen Fordham verfasserin aut Elen Vink verfasserin aut Victoria Ward verfasserin aut Anna Smith verfasserin aut Andrew Rosser verfasserin aut Alison Muir verfasserin aut Ken Woodhouse verfasserin aut John Shone verfasserin aut Iain Crossingham verfasserin aut Ryan Jayesinghe verfasserin aut Eavan Muldoon verfasserin aut Avneet Shahi verfasserin aut Terry John Evans verfasserin aut Jeremy Wong verfasserin aut Eloisa MacLachlan verfasserin aut Amy Chue verfasserin aut Karishma Gokani verfasserin aut Katherine Ajdukiewicz verfasserin aut Lucinda Barrett verfasserin aut Frances Edwards verfasserin aut Adam Usher verfasserin aut Mairi McLeod verfasserin aut Su su Htwe verfasserin aut Grace Duane verfasserin aut Nicholas Wong verfasserin aut Jennifer Poyner verfasserin aut Jenni Crane verfasserin aut Ollie Lloyd verfasserin aut Emma Chisholm verfasserin aut Ildiko Kustos verfasserin aut Sam Sutton verfasserin aut M. Estee Torok verfasserin aut Isobel Ramsay verfasserin aut Monica Ivan verfasserin aut Joshua York verfasserin aut Jennifer Ansett verfasserin aut Maithili Varadarajan verfasserin aut Priya Sekhon verfasserin aut James Cruise verfasserin aut Shivani Kanabar verfasserin aut Mirella Ling verfasserin aut Charlotte Milne verfasserin aut Jayanta Sarma verfasserin aut Aline Wilson verfasserin aut Lynn Urquhart verfasserin aut Sahar Eldirdiri verfasserin aut Leila White verfasserin aut Jody Aberdein verfasserin aut Phillip Simpson verfasserin aut Hnin Hay Mar verfasserin aut Keying Tan verfasserin aut Eint Shwe Zin thein verfasserin aut Mahmoud Aziz verfasserin aut Anthony Cadwgan verfasserin aut Natasha Weston verfasserin aut Salman Zeb verfasserin aut Angela Houston verfasserin aut Louise Wootton verfasserin aut Iona Willingham verfasserin aut Aimee Johnson verfasserin aut Ashley Horsley verfasserin aut Eamonn Trainor verfasserin aut Olivier Gaillemin verfasserin aut Nicholas J Norton verfasserin aut Katie Cheung verfasserin aut Megan Duxbury verfasserin aut Emilie Bellhouse verfasserin aut Helena Brezovjakova verfasserin aut Kanitkar Tanmay verfasserin aut Alexsander Dawidziuk verfasserin aut Razan Saman verfasserin aut Hugh Adler verfasserin aut Elshadai Ejere verfasserin aut Yiwen Soo verfasserin aut Wendy Beadles verfasserin aut Heather Sturgeon verfasserin aut Brodie Cameron verfasserin aut David Chadwick Ben Tomlinson verfasserin aut Claire McGoldrick verfasserin aut Katie McDowell verfasserin aut Mpho Molosiwa verfasserin aut Katherine FlackAdrian Kennedy verfasserin aut Phoebe Cross verfasserin aut Fay Perry verfasserin aut Vithusha Inpadhas verfasserin aut Sarathy Selvam verfasserin aut Vhairi Bateman verfasserin aut Henry Wu verfasserin aut Monika Pasztor verfasserin aut Ajanthiha Karunakaran verfasserin aut Basma Soliman verfasserin aut Andrew Blanshard verfasserin aut Harish Reddy verfasserin aut Helen Chesterfield verfasserin aut Ben Schroeder verfasserin aut Tee Keat Teoh verfasserin aut Sathyavani Subbarao verfasserin aut Caryn RosmarinLucy Bell verfasserin aut Emma McGuire verfasserin aut Robert Serafino verfasserin aut Ishaan Bhide verfasserin aut Karanjeet Sagoo verfasserin aut Indran Balakrishnan verfasserin aut Kajal Patel verfasserin aut Barzo Faris verfasserin aut Graeme Calver verfasserin aut Ricky Singh verfasserin aut Hazel Sanghvi verfasserin aut Mohamed Eltayeb verfasserin aut Rathur Haris verfasserin aut In BMJ Open BMJ Publishing Group, 2011 12(2022), 7 (DE-627)654747075 (DE-600)2599832-8 20446055 nnns volume:12 year:2022 number:7 https://doi.org/10.1136/bmjopen-2022-062698 kostenfrei https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 kostenfrei https://bmjopen.bmj.com/content/12/7/e062698.full kostenfrei https://doaj.org/toc/2044-6055 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 7
allfields_unstemmed	10.1136/bmjopen-2022-062698 doi (DE-627)DOAJ041417747 (DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4 DE-627 ger DE-627 rakwb eng Amy Robinson verfasserin aut Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Medicine R Kamaljit Khalsa verfasserin aut Arjun Chandna verfasserin aut John Bowen verfasserin aut Viva Levee verfasserin aut Jan Coebergh verfasserin aut Tom Solomon verfasserin aut Clive Graham verfasserin aut David Turner verfasserin aut Robert Tilley verfasserin aut Tim Jones verfasserin aut Susan Hopkins verfasserin aut Matthew Stevens verfasserin aut Daniel White verfasserin aut Celestine Eshiwe verfasserin aut Anna Goodman verfasserin aut Ramandeep Singh verfasserin aut Robert S Heyderman verfasserin aut Nicholas Davies verfasserin aut Joseph Thompson verfasserin aut Ed Moran verfasserin aut Sarah Kelly verfasserin aut Martin Williams verfasserin aut Rhea O’Regan verfasserin aut Simon Tiberi verfasserin aut Jonathan Lambourne verfasserin aut Naomi Bulteel verfasserin aut Susan Larkin verfasserin aut Ruth McEwen verfasserin aut Hassan Paraiso verfasserin aut Aarti Shah verfasserin aut Martin Wiselka verfasserin aut Sylviane Defres verfasserin aut Ernest Mutengesa verfasserin aut Maria Krutikov verfasserin aut Ruth Owen verfasserin aut David Griffith verfasserin aut David Harvey verfasserin aut Trupti Patel verfasserin aut Brendan Davies verfasserin aut Emma Mclean verfasserin aut Joanna Allen verfasserin aut Ali Khan verfasserin aut Alastair Miller verfasserin aut Ashutosh Deshpande verfasserin aut Christopher Green verfasserin aut Lewis Jones verfasserin aut Mark Melzer verfasserin aut Fiona McGill verfasserin aut Amanda Fife verfasserin aut Nimal Wickramasinghe verfasserin aut Stephanie Harris verfasserin aut Ewan Hunter verfasserin aut Jayne Ellis verfasserin aut Benedict Rogers verfasserin aut Imogen Fordham verfasserin aut Elen Vink verfasserin aut Victoria Ward verfasserin aut Anna Smith verfasserin aut Andrew Rosser verfasserin aut Alison Muir verfasserin aut Ken Woodhouse verfasserin aut John Shone verfasserin aut Iain Crossingham verfasserin aut Ryan Jayesinghe verfasserin aut Eavan Muldoon verfasserin aut Avneet Shahi verfasserin aut Terry John Evans verfasserin aut Jeremy Wong verfasserin aut Eloisa MacLachlan verfasserin aut Amy Chue verfasserin aut Karishma Gokani verfasserin aut Katherine Ajdukiewicz verfasserin aut Lucinda Barrett verfasserin aut Frances Edwards verfasserin aut Adam Usher verfasserin aut Mairi McLeod verfasserin aut Su su Htwe verfasserin aut Grace Duane verfasserin aut Nicholas Wong verfasserin aut Jennifer Poyner verfasserin aut Jenni Crane verfasserin aut Ollie Lloyd verfasserin aut Emma Chisholm verfasserin aut Ildiko Kustos verfasserin aut Sam Sutton verfasserin aut M. Estee Torok verfasserin aut Isobel Ramsay verfasserin aut Monica Ivan verfasserin aut Joshua York verfasserin aut Jennifer Ansett verfasserin aut Maithili Varadarajan verfasserin aut Priya Sekhon verfasserin aut James Cruise verfasserin aut Shivani Kanabar verfasserin aut Mirella Ling verfasserin aut Charlotte Milne verfasserin aut Jayanta Sarma verfasserin aut Aline Wilson verfasserin aut Lynn Urquhart verfasserin aut Sahar Eldirdiri verfasserin aut Leila White verfasserin aut Jody Aberdein verfasserin aut Phillip Simpson verfasserin aut Hnin Hay Mar verfasserin aut Keying Tan verfasserin aut Eint Shwe Zin thein verfasserin aut Mahmoud Aziz verfasserin aut Anthony Cadwgan verfasserin aut Natasha Weston verfasserin aut Salman Zeb verfasserin aut Angela Houston verfasserin aut Louise Wootton verfasserin aut Iona Willingham verfasserin aut Aimee Johnson verfasserin aut Ashley Horsley verfasserin aut Eamonn Trainor verfasserin aut Olivier Gaillemin verfasserin aut Nicholas J Norton verfasserin aut Katie Cheung verfasserin aut Megan Duxbury verfasserin aut Emilie Bellhouse verfasserin aut Helena Brezovjakova verfasserin aut Kanitkar Tanmay verfasserin aut Alexsander Dawidziuk verfasserin aut Razan Saman verfasserin aut Hugh Adler verfasserin aut Elshadai Ejere verfasserin aut Yiwen Soo verfasserin aut Wendy Beadles verfasserin aut Heather Sturgeon verfasserin aut Brodie Cameron verfasserin aut David Chadwick Ben Tomlinson verfasserin aut Claire McGoldrick verfasserin aut Katie McDowell verfasserin aut Mpho Molosiwa verfasserin aut Katherine FlackAdrian Kennedy verfasserin aut Phoebe Cross verfasserin aut Fay Perry verfasserin aut Vithusha Inpadhas verfasserin aut Sarathy Selvam verfasserin aut Vhairi Bateman verfasserin aut Henry Wu verfasserin aut Monika Pasztor verfasserin aut Ajanthiha Karunakaran verfasserin aut Basma Soliman verfasserin aut Andrew Blanshard verfasserin aut Harish Reddy verfasserin aut Helen Chesterfield verfasserin aut Ben Schroeder verfasserin aut Tee Keat Teoh verfasserin aut Sathyavani Subbarao verfasserin aut Caryn RosmarinLucy Bell verfasserin aut Emma McGuire verfasserin aut Robert Serafino verfasserin aut Ishaan Bhide verfasserin aut Karanjeet Sagoo verfasserin aut Indran Balakrishnan verfasserin aut Kajal Patel verfasserin aut Barzo Faris verfasserin aut Graeme Calver verfasserin aut Ricky Singh verfasserin aut Hazel Sanghvi verfasserin aut Mohamed Eltayeb verfasserin aut Rathur Haris verfasserin aut In BMJ Open BMJ Publishing Group, 2011 12(2022), 7 (DE-627)654747075 (DE-600)2599832-8 20446055 nnns volume:12 year:2022 number:7 https://doi.org/10.1136/bmjopen-2022-062698 kostenfrei https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 kostenfrei https://bmjopen.bmj.com/content/12/7/e062698.full kostenfrei https://doaj.org/toc/2044-6055 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 7
allfieldsGer	10.1136/bmjopen-2022-062698 doi (DE-627)DOAJ041417747 (DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4 DE-627 ger DE-627 rakwb eng Amy Robinson verfasserin aut Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Medicine R Kamaljit Khalsa verfasserin aut Arjun Chandna verfasserin aut John Bowen verfasserin aut Viva Levee verfasserin aut Jan Coebergh verfasserin aut Tom Solomon verfasserin aut Clive Graham verfasserin aut David Turner verfasserin aut Robert Tilley verfasserin aut Tim Jones verfasserin aut Susan Hopkins verfasserin aut Matthew Stevens verfasserin aut Daniel White verfasserin aut Celestine Eshiwe verfasserin aut Anna Goodman verfasserin aut Ramandeep Singh verfasserin aut Robert S Heyderman verfasserin aut Nicholas Davies verfasserin aut Joseph Thompson verfasserin aut Ed Moran verfasserin aut Sarah Kelly verfasserin aut Martin Williams verfasserin aut Rhea O’Regan verfasserin aut Simon Tiberi verfasserin aut Jonathan Lambourne verfasserin aut Naomi Bulteel verfasserin aut Susan Larkin verfasserin aut Ruth McEwen verfasserin aut Hassan Paraiso verfasserin aut Aarti Shah verfasserin aut Martin Wiselka verfasserin aut Sylviane Defres verfasserin aut Ernest Mutengesa verfasserin aut Maria Krutikov verfasserin aut Ruth Owen verfasserin aut David Griffith verfasserin aut David Harvey verfasserin aut Trupti Patel verfasserin aut Brendan Davies verfasserin aut Emma Mclean verfasserin aut Joanna Allen verfasserin aut Ali Khan verfasserin aut Alastair Miller verfasserin aut Ashutosh Deshpande verfasserin aut Christopher Green verfasserin aut Lewis Jones verfasserin aut Mark Melzer verfasserin aut Fiona McGill verfasserin aut Amanda Fife verfasserin aut Nimal Wickramasinghe verfasserin aut Stephanie Harris verfasserin aut Ewan Hunter verfasserin aut Jayne Ellis verfasserin aut Benedict Rogers verfasserin aut Imogen Fordham verfasserin aut Elen Vink verfasserin aut Victoria Ward verfasserin aut Anna Smith verfasserin aut Andrew Rosser verfasserin aut Alison Muir verfasserin aut Ken Woodhouse verfasserin aut John Shone verfasserin aut Iain Crossingham verfasserin aut Ryan Jayesinghe verfasserin aut Eavan Muldoon verfasserin aut Avneet Shahi verfasserin aut Terry John Evans verfasserin aut Jeremy Wong verfasserin aut Eloisa MacLachlan verfasserin aut Amy Chue verfasserin aut Karishma Gokani verfasserin aut Katherine Ajdukiewicz verfasserin aut Lucinda Barrett verfasserin aut Frances Edwards verfasserin aut Adam Usher verfasserin aut Mairi McLeod verfasserin aut Su su Htwe verfasserin aut Grace Duane verfasserin aut Nicholas Wong verfasserin aut Jennifer Poyner verfasserin aut Jenni Crane verfasserin aut Ollie Lloyd verfasserin aut Emma Chisholm verfasserin aut Ildiko Kustos verfasserin aut Sam Sutton verfasserin aut M. Estee Torok verfasserin aut Isobel Ramsay verfasserin aut Monica Ivan verfasserin aut Joshua York verfasserin aut Jennifer Ansett verfasserin aut Maithili Varadarajan verfasserin aut Priya Sekhon verfasserin aut James Cruise verfasserin aut Shivani Kanabar verfasserin aut Mirella Ling verfasserin aut Charlotte Milne verfasserin aut Jayanta Sarma verfasserin aut Aline Wilson verfasserin aut Lynn Urquhart verfasserin aut Sahar Eldirdiri verfasserin aut Leila White verfasserin aut Jody Aberdein verfasserin aut Phillip Simpson verfasserin aut Hnin Hay Mar verfasserin aut Keying Tan verfasserin aut Eint Shwe Zin thein verfasserin aut Mahmoud Aziz verfasserin aut Anthony Cadwgan verfasserin aut Natasha Weston verfasserin aut Salman Zeb verfasserin aut Angela Houston verfasserin aut Louise Wootton verfasserin aut Iona Willingham verfasserin aut Aimee Johnson verfasserin aut Ashley Horsley verfasserin aut Eamonn Trainor verfasserin aut Olivier Gaillemin verfasserin aut Nicholas J Norton verfasserin aut Katie Cheung verfasserin aut Megan Duxbury verfasserin aut Emilie Bellhouse verfasserin aut Helena Brezovjakova verfasserin aut Kanitkar Tanmay verfasserin aut Alexsander Dawidziuk verfasserin aut Razan Saman verfasserin aut Hugh Adler verfasserin aut Elshadai Ejere verfasserin aut Yiwen Soo verfasserin aut Wendy Beadles verfasserin aut Heather Sturgeon verfasserin aut Brodie Cameron verfasserin aut David Chadwick Ben Tomlinson verfasserin aut Claire McGoldrick verfasserin aut Katie McDowell verfasserin aut Mpho Molosiwa verfasserin aut Katherine FlackAdrian Kennedy verfasserin aut Phoebe Cross verfasserin aut Fay Perry verfasserin aut Vithusha Inpadhas verfasserin aut Sarathy Selvam verfasserin aut Vhairi Bateman verfasserin aut Henry Wu verfasserin aut Monika Pasztor verfasserin aut Ajanthiha Karunakaran verfasserin aut Basma Soliman verfasserin aut Andrew Blanshard verfasserin aut Harish Reddy verfasserin aut Helen Chesterfield verfasserin aut Ben Schroeder verfasserin aut Tee Keat Teoh verfasserin aut Sathyavani Subbarao verfasserin aut Caryn RosmarinLucy Bell verfasserin aut Emma McGuire verfasserin aut Robert Serafino verfasserin aut Ishaan Bhide verfasserin aut Karanjeet Sagoo verfasserin aut Indran Balakrishnan verfasserin aut Kajal Patel verfasserin aut Barzo Faris verfasserin aut Graeme Calver verfasserin aut Ricky Singh verfasserin aut Hazel Sanghvi verfasserin aut Mohamed Eltayeb verfasserin aut Rathur Haris verfasserin aut In BMJ Open BMJ Publishing Group, 2011 12(2022), 7 (DE-627)654747075 (DE-600)2599832-8 20446055 nnns volume:12 year:2022 number:7 https://doi.org/10.1136/bmjopen-2022-062698 kostenfrei https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 kostenfrei https://bmjopen.bmj.com/content/12/7/e062698.full kostenfrei https://doaj.org/toc/2044-6055 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 7
allfieldsSound	10.1136/bmjopen-2022-062698 doi (DE-627)DOAJ041417747 (DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4 DE-627 ger DE-627 rakwb eng Amy Robinson verfasserin aut Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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. Medicine R Kamaljit Khalsa verfasserin aut Arjun Chandna verfasserin aut John Bowen verfasserin aut Viva Levee verfasserin aut Jan Coebergh verfasserin aut Tom Solomon verfasserin aut Clive Graham verfasserin aut David Turner verfasserin aut Robert Tilley verfasserin aut Tim Jones verfasserin aut Susan Hopkins verfasserin aut Matthew Stevens verfasserin aut Daniel White verfasserin aut Celestine Eshiwe verfasserin aut Anna Goodman verfasserin aut Ramandeep Singh verfasserin aut Robert S Heyderman verfasserin aut Nicholas Davies verfasserin aut Joseph Thompson verfasserin aut Ed Moran verfasserin aut Sarah Kelly verfasserin aut Martin Williams verfasserin aut Rhea O’Regan verfasserin aut Simon Tiberi verfasserin aut Jonathan Lambourne verfasserin aut Naomi Bulteel verfasserin aut Susan Larkin verfasserin aut Ruth McEwen verfasserin aut Hassan Paraiso verfasserin aut Aarti Shah verfasserin aut Martin Wiselka verfasserin aut Sylviane Defres verfasserin aut Ernest Mutengesa verfasserin aut Maria Krutikov verfasserin aut Ruth Owen verfasserin aut David Griffith verfasserin aut David Harvey verfasserin aut Trupti Patel verfasserin aut Brendan Davies verfasserin aut Emma Mclean verfasserin aut Joanna Allen verfasserin aut Ali Khan verfasserin aut Alastair Miller verfasserin aut Ashutosh Deshpande verfasserin aut Christopher Green verfasserin aut Lewis Jones verfasserin aut Mark Melzer verfasserin aut Fiona McGill verfasserin aut Amanda Fife verfasserin aut Nimal Wickramasinghe verfasserin aut Stephanie Harris verfasserin aut Ewan Hunter verfasserin aut Jayne Ellis verfasserin aut Benedict Rogers verfasserin aut Imogen Fordham verfasserin aut Elen Vink verfasserin aut Victoria Ward verfasserin aut Anna Smith verfasserin aut Andrew Rosser verfasserin aut Alison Muir verfasserin aut Ken Woodhouse verfasserin aut John Shone verfasserin aut Iain Crossingham verfasserin aut Ryan Jayesinghe verfasserin aut Eavan Muldoon verfasserin aut Avneet Shahi verfasserin aut Terry John Evans verfasserin aut Jeremy Wong verfasserin aut Eloisa MacLachlan verfasserin aut Amy Chue verfasserin aut Karishma Gokani verfasserin aut Katherine Ajdukiewicz verfasserin aut Lucinda Barrett verfasserin aut Frances Edwards verfasserin aut Adam Usher verfasserin aut Mairi McLeod verfasserin aut Su su Htwe verfasserin aut Grace Duane verfasserin aut Nicholas Wong verfasserin aut Jennifer Poyner verfasserin aut Jenni Crane verfasserin aut Ollie Lloyd verfasserin aut Emma Chisholm verfasserin aut Ildiko Kustos verfasserin aut Sam Sutton verfasserin aut M. Estee Torok verfasserin aut Isobel Ramsay verfasserin aut Monica Ivan verfasserin aut Joshua York verfasserin aut Jennifer Ansett verfasserin aut Maithili Varadarajan verfasserin aut Priya Sekhon verfasserin aut James Cruise verfasserin aut Shivani Kanabar verfasserin aut Mirella Ling verfasserin aut Charlotte Milne verfasserin aut Jayanta Sarma verfasserin aut Aline Wilson verfasserin aut Lynn Urquhart verfasserin aut Sahar Eldirdiri verfasserin aut Leila White verfasserin aut Jody Aberdein verfasserin aut Phillip Simpson verfasserin aut Hnin Hay Mar verfasserin aut Keying Tan verfasserin aut Eint Shwe Zin thein verfasserin aut Mahmoud Aziz verfasserin aut Anthony Cadwgan verfasserin aut Natasha Weston verfasserin aut Salman Zeb verfasserin aut Angela Houston verfasserin aut Louise Wootton verfasserin aut Iona Willingham verfasserin aut Aimee Johnson verfasserin aut Ashley Horsley verfasserin aut Eamonn Trainor verfasserin aut Olivier Gaillemin verfasserin aut Nicholas J Norton verfasserin aut Katie Cheung verfasserin aut Megan Duxbury verfasserin aut Emilie Bellhouse verfasserin aut Helena Brezovjakova verfasserin aut Kanitkar Tanmay verfasserin aut Alexsander Dawidziuk verfasserin aut Razan Saman verfasserin aut Hugh Adler verfasserin aut Elshadai Ejere verfasserin aut Yiwen Soo verfasserin aut Wendy Beadles verfasserin aut Heather Sturgeon verfasserin aut Brodie Cameron verfasserin aut David Chadwick Ben Tomlinson verfasserin aut Claire McGoldrick verfasserin aut Katie McDowell verfasserin aut Mpho Molosiwa verfasserin aut Katherine FlackAdrian Kennedy verfasserin aut Phoebe Cross verfasserin aut Fay Perry verfasserin aut Vithusha Inpadhas verfasserin aut Sarathy Selvam verfasserin aut Vhairi Bateman verfasserin aut Henry Wu verfasserin aut Monika Pasztor verfasserin aut Ajanthiha Karunakaran verfasserin aut Basma Soliman verfasserin aut Andrew Blanshard verfasserin aut Harish Reddy verfasserin aut Helen Chesterfield verfasserin aut Ben Schroeder verfasserin aut Tee Keat Teoh verfasserin aut Sathyavani Subbarao verfasserin aut Caryn RosmarinLucy Bell verfasserin aut Emma McGuire verfasserin aut Robert Serafino verfasserin aut Ishaan Bhide verfasserin aut Karanjeet Sagoo verfasserin aut Indran Balakrishnan verfasserin aut Kajal Patel verfasserin aut Barzo Faris verfasserin aut Graeme Calver verfasserin aut Ricky Singh verfasserin aut Hazel Sanghvi verfasserin aut Mohamed Eltayeb verfasserin aut Rathur Haris verfasserin aut In BMJ Open BMJ Publishing Group, 2011 12(2022), 7 (DE-627)654747075 (DE-600)2599832-8 20446055 nnns volume:12 year:2022 number:7 https://doi.org/10.1136/bmjopen-2022-062698 kostenfrei https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 kostenfrei https://bmjopen.bmj.com/content/12/7/e062698.full kostenfrei https://doaj.org/toc/2044-6055 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2022 7
language	English
source	In BMJ Open 12(2022), 7 volume:12 year:2022 number:7
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container_title	BMJ Open
authorswithroles_txt_mv	Amy Robinson @@aut@@ Kamaljit Khalsa @@aut@@ Arjun Chandna @@aut@@ John Bowen @@aut@@ Viva Levee @@aut@@ Jan Coebergh @@aut@@ Tom Solomon @@aut@@ Clive Graham @@aut@@ David Turner @@aut@@ Robert Tilley @@aut@@ Tim Jones @@aut@@ Susan Hopkins @@aut@@ Matthew Stevens @@aut@@ Daniel White @@aut@@ Celestine Eshiwe @@aut@@ Anna Goodman @@aut@@ Ramandeep Singh @@aut@@ Robert S Heyderman @@aut@@ Nicholas Davies @@aut@@ Joseph Thompson @@aut@@ Ed Moran @@aut@@ Sarah Kelly @@aut@@ Martin Williams @@aut@@ Rhea O’Regan @@aut@@ Simon Tiberi @@aut@@ Jonathan Lambourne @@aut@@ Naomi Bulteel @@aut@@ Susan Larkin @@aut@@ Ruth McEwen @@aut@@ Hassan Paraiso @@aut@@ Aarti Shah @@aut@@ Martin Wiselka @@aut@@ Sylviane Defres @@aut@@ Ernest Mutengesa @@aut@@ Maria Krutikov @@aut@@ Ruth Owen @@aut@@ David Griffith @@aut@@ David Harvey @@aut@@ Trupti Patel @@aut@@ Brendan Davies @@aut@@ Emma Mclean @@aut@@ Joanna Allen @@aut@@ Ali Khan @@aut@@ Alastair Miller @@aut@@ Ashutosh Deshpande @@aut@@ Christopher Green @@aut@@ Lewis Jones @@aut@@ Mark Melzer @@aut@@ Fiona McGill @@aut@@ Amanda Fife @@aut@@ Nimal Wickramasinghe @@aut@@ Stephanie Harris @@aut@@ Ewan Hunter @@aut@@ Jayne Ellis @@aut@@ Benedict Rogers @@aut@@ Imogen Fordham @@aut@@ Elen Vink @@aut@@ Victoria Ward @@aut@@ Anna Smith @@aut@@ Andrew Rosser @@aut@@ Alison Muir @@aut@@ Ken Woodhouse @@aut@@ John Shone @@aut@@ Iain Crossingham @@aut@@ Ryan Jayesinghe @@aut@@ Eavan Muldoon @@aut@@ Avneet Shahi @@aut@@ Terry John Evans @@aut@@ Jeremy Wong @@aut@@ Eloisa MacLachlan @@aut@@ Amy Chue @@aut@@ Karishma Gokani @@aut@@ Katherine Ajdukiewicz @@aut@@ Lucinda Barrett @@aut@@ Frances Edwards @@aut@@ Adam Usher @@aut@@ Mairi McLeod @@aut@@ Su su Htwe @@aut@@ Grace Duane @@aut@@ Nicholas Wong @@aut@@ Jennifer Poyner @@aut@@ Jenni Crane @@aut@@ Ollie Lloyd @@aut@@ Emma Chisholm @@aut@@ Ildiko Kustos @@aut@@ Sam Sutton @@aut@@ M. Estee Torok @@aut@@ Isobel Ramsay @@aut@@ Monica Ivan @@aut@@ Joshua York @@aut@@ Jennifer Ansett @@aut@@ Maithili Varadarajan @@aut@@ Priya Sekhon @@aut@@ James Cruise @@aut@@ Shivani Kanabar @@aut@@ Mirella Ling @@aut@@ Charlotte Milne @@aut@@ Jayanta Sarma @@aut@@ Aline Wilson @@aut@@ Lynn Urquhart @@aut@@ Sahar Eldirdiri @@aut@@ Leila White @@aut@@ Jody Aberdein @@aut@@ Phillip Simpson @@aut@@ Hnin Hay Mar @@aut@@ Keying Tan @@aut@@ Eint Shwe Zin thein @@aut@@ Mahmoud Aziz @@aut@@ Anthony Cadwgan @@aut@@ Natasha Weston @@aut@@ Salman Zeb @@aut@@ Angela Houston @@aut@@ Louise Wootton @@aut@@ Iona Willingham @@aut@@ Aimee Johnson @@aut@@ Ashley Horsley @@aut@@ Eamonn Trainor @@aut@@ Olivier Gaillemin @@aut@@ Nicholas J Norton @@aut@@ Katie Cheung @@aut@@ Megan Duxbury @@aut@@ Emilie Bellhouse @@aut@@ Helena Brezovjakova @@aut@@ Kanitkar Tanmay @@aut@@ Alexsander Dawidziuk @@aut@@ Razan Saman @@aut@@ Hugh Adler @@aut@@ Elshadai Ejere @@aut@@ Yiwen Soo @@aut@@ Wendy Beadles @@aut@@ Heather Sturgeon @@aut@@ Brodie Cameron @@aut@@ David Chadwick Ben Tomlinson @@aut@@ Claire McGoldrick @@aut@@ Katie McDowell @@aut@@ Mpho Molosiwa @@aut@@ Katherine FlackAdrian Kennedy @@aut@@ Phoebe Cross @@aut@@ Fay Perry @@aut@@ Vithusha Inpadhas @@aut@@ Sarathy Selvam @@aut@@ Vhairi Bateman @@aut@@ Henry Wu @@aut@@ Monika Pasztor @@aut@@ Ajanthiha Karunakaran @@aut@@ Basma Soliman @@aut@@ Andrew Blanshard @@aut@@ Harish Reddy @@aut@@ Helen Chesterfield @@aut@@ Ben Schroeder @@aut@@ Tee Keat Teoh @@aut@@ Sathyavani Subbarao @@aut@@ Caryn RosmarinLucy Bell @@aut@@ Emma McGuire @@aut@@ Robert Serafino @@aut@@ Ishaan Bhide @@aut@@ Karanjeet Sagoo @@aut@@ Indran Balakrishnan @@aut@@ Kajal Patel @@aut@@ Barzo Faris @@aut@@ Graeme Calver @@aut@@ Ricky Singh @@aut@@ Hazel Sanghvi @@aut@@ Mohamed Eltayeb @@aut@@ Rathur Haris @@aut@@
publishDateDaySort_date	2022-01-01T00:00:00Z
hierarchy_top_id	654747075
id	DOAJ041417747
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ041417747</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230308050017.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230227s2022 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1136/bmjopen-2022-062698</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ041417747</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ5f3d2b2bc42b4354baffd7ae95ec84b4</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Amy Robinson</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2022</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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.</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">R</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Kamaljit Khalsa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Arjun Chandna</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">John Bowen</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Viva Levee</subfield><subfield code="e">verfasserin</subfield><subfield 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author	Amy Robinson
spellingShingle	Amy Robinson misc Medicine misc R Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
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topic_title	Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
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title	Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
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title_full	Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
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author_browse	Amy Robinson Kamaljit Khalsa Arjun Chandna John Bowen Viva Levee Jan Coebergh Tom Solomon Clive Graham David Turner Robert Tilley Tim Jones Susan Hopkins Matthew Stevens Daniel White Celestine Eshiwe Anna Goodman Ramandeep Singh Robert S Heyderman Nicholas Davies Joseph Thompson Ed Moran Sarah Kelly Martin Williams Rhea O’Regan Simon Tiberi Jonathan Lambourne Naomi Bulteel Susan Larkin Ruth McEwen Hassan Paraiso Aarti Shah Martin Wiselka Sylviane Defres Ernest Mutengesa Maria Krutikov Ruth Owen David Griffith David Harvey Trupti Patel Brendan Davies Emma Mclean Joanna Allen Ali Khan Alastair Miller Ashutosh Deshpande Christopher Green Lewis Jones Mark Melzer Fiona McGill Amanda Fife Nimal Wickramasinghe Stephanie Harris Ewan Hunter Jayne Ellis Benedict Rogers Imogen Fordham Elen Vink Victoria Ward Anna Smith Andrew Rosser Alison Muir Ken Woodhouse John Shone Iain Crossingham Ryan Jayesinghe Eavan Muldoon Avneet Shahi Terry John Evans Jeremy Wong Eloisa MacLachlan Amy Chue Karishma Gokani Katherine Ajdukiewicz Lucinda Barrett Frances Edwards Adam Usher Mairi McLeod Su su Htwe Grace Duane Nicholas Wong Jennifer Poyner Jenni Crane Ollie Lloyd Emma Chisholm Ildiko Kustos Sam Sutton M. Estee Torok Isobel Ramsay Monica Ivan Joshua York Jennifer Ansett Maithili Varadarajan Priya Sekhon James Cruise Shivani Kanabar Mirella Ling Charlotte Milne Jayanta Sarma Aline Wilson Lynn Urquhart Sahar Eldirdiri Leila White Jody Aberdein Phillip Simpson Hnin Hay Mar Keying Tan Eint Shwe Zin thein Mahmoud Aziz Anthony Cadwgan Natasha Weston Salman Zeb Angela Houston Louise Wootton Iona Willingham Aimee Johnson Ashley Horsley Eamonn Trainor Olivier Gaillemin Nicholas J Norton Katie Cheung Megan Duxbury Emilie Bellhouse Helena Brezovjakova Kanitkar Tanmay Alexsander Dawidziuk Razan Saman Hugh Adler Elshadai Ejere Yiwen Soo Wendy Beadles Heather Sturgeon Brodie Cameron David Chadwick Ben Tomlinson Claire McGoldrick Katie McDowell Mpho Molosiwa Katherine FlackAdrian Kennedy Phoebe Cross Fay Perry Vithusha Inpadhas Sarathy Selvam Vhairi Bateman Henry Wu Monika Pasztor Ajanthiha Karunakaran Basma Soliman Andrew Blanshard Harish Reddy Helen Chesterfield Ben Schroeder Tee Keat Teoh Sathyavani Subbarao Caryn RosmarinLucy Bell Emma McGuire Robert Serafino Ishaan Bhide Karanjeet Sagoo Indran Balakrishnan Kajal Patel Barzo Faris Graeme Calver Ricky Singh Hazel Sanghvi Mohamed Eltayeb Rathur Haris
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title_sort	clinical management of community-acquired meningitis in adults in the uk and ireland in 2017: a retrospective cohort study on behalf of the national infection trainees collaborative for audit and research (nitcar)
title_auth	Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
abstract	Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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.
abstractGer	Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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.
abstract_unstemmed	Objectives To assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland.Design Retrospective cohort study.Setting 64 UK and Irish hospitals.Participants 1471 adults with community-acquired meningitis of any aetiology in 2017.Results None 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).Conclusion This 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.
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title_short	Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)
url	https://doi.org/10.1136/bmjopen-2022-062698 https://doaj.org/article/5f3d2b2bc42b4354baffd7ae95ec84b4 https://bmjopen.bmj.com/content/12/7/e062698.full https://doaj.org/toc/2044-6055
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author2	Kamaljit Khalsa Arjun Chandna John Bowen Viva Levee Jan Coebergh Tom Solomon Clive Graham David Turner Robert Tilley Tim Jones Susan Hopkins Matthew Stevens Daniel White Celestine Eshiwe Anna Goodman Ramandeep Singh Robert S Heyderman Nicholas Davies Joseph Thompson Ed Moran Sarah Kelly Martin Williams Rhea O’Regan Simon Tiberi Jonathan Lambourne Naomi Bulteel Susan Larkin Ruth McEwen Hassan Paraiso Aarti Shah Martin Wiselka Sylviane Defres Ernest Mutengesa Maria Krutikov Ruth Owen David Griffith David Harvey Trupti Patel Brendan Davies Emma Mclean Joanna Allen Ali Khan Alastair Miller Ashutosh Deshpande Christopher Green Lewis Jones Mark Melzer Fiona McGill Amanda Fife Nimal Wickramasinghe Stephanie Harris Ewan Hunter Jayne Ellis Benedict Rogers Imogen Fordham Elen Vink Victoria Ward Anna Smith Andrew Rosser Alison Muir Ken Woodhouse John Shone Iain Crossingham Ryan Jayesinghe Eavan Muldoon Avneet Shahi Terry John Evans Jeremy Wong Eloisa MacLachlan Amy Chue Karishma Gokani Katherine Ajdukiewicz Lucinda Barrett Frances Edwards Adam Usher Mairi McLeod Su su Htwe Grace Duane Nicholas Wong Jennifer Poyner Jenni Crane Ollie Lloyd Emma Chisholm Ildiko Kustos Sam Sutton M. Estee Torok Isobel Ramsay Monica Ivan Joshua York Jennifer Ansett Maithili Varadarajan Priya Sekhon James Cruise Shivani Kanabar Mirella Ling Charlotte Milne Jayanta Sarma Aline Wilson Lynn Urquhart Sahar Eldirdiri Leila White Jody Aberdein Phillip Simpson Hnin Hay Mar Keying Tan Eint Shwe Zin thein Mahmoud Aziz Anthony Cadwgan Natasha Weston Salman Zeb Angela Houston Louise Wootton Iona Willingham Aimee Johnson Ashley Horsley Eamonn Trainor Olivier Gaillemin Nicholas J Norton Katie Cheung Megan Duxbury Emilie Bellhouse Helena Brezovjakova Kanitkar Tanmay Alexsander Dawidziuk Razan Saman Hugh Adler Elshadai Ejere Yiwen Soo Wendy Beadles Heather Sturgeon Brodie Cameron David Chadwick Ben Tomlinson Claire McGoldrick Katie McDowell Mpho Molosiwa Katherine FlackAdrian Kennedy Phoebe Cross Fay Perry Vithusha Inpadhas Sarathy Selvam Vhairi Bateman Henry Wu Monika Pasztor Ajanthiha Karunakaran Basma Soliman Andrew Blanshard Harish Reddy Helen Chesterfield Ben Schroeder Tee Keat Teoh Sathyavani Subbarao Caryn RosmarinLucy Bell Emma McGuire Robert Serafino Ishaan Bhide Karanjeet Sagoo Indran Balakrishnan Kajal Patel Barzo Faris Graeme Calver Ricky Singh Hazel Sanghvi Mohamed Eltayeb Rathur Haris
author2Str	Kamaljit Khalsa Arjun Chandna John Bowen Viva Levee Jan Coebergh Tom Solomon Clive Graham David Turner Robert Tilley Tim Jones Susan Hopkins Matthew Stevens Daniel White Celestine Eshiwe Anna Goodman Ramandeep Singh Robert S Heyderman Nicholas Davies Joseph Thompson Ed Moran Sarah Kelly Martin Williams Rhea O’Regan Simon Tiberi Jonathan Lambourne Naomi Bulteel Susan Larkin Ruth McEwen Hassan Paraiso Aarti Shah Martin Wiselka Sylviane Defres Ernest Mutengesa Maria Krutikov Ruth Owen David Griffith David Harvey Trupti Patel Brendan Davies Emma Mclean Joanna Allen Ali Khan Alastair Miller Ashutosh Deshpande Christopher Green Lewis Jones Mark Melzer Fiona McGill Amanda Fife Nimal Wickramasinghe Stephanie Harris Ewan Hunter Jayne Ellis Benedict Rogers Imogen Fordham Elen Vink Victoria Ward Anna Smith Andrew Rosser Alison Muir Ken Woodhouse John Shone Iain Crossingham Ryan Jayesinghe Eavan Muldoon Avneet Shahi Terry John Evans Jeremy Wong Eloisa MacLachlan Amy Chue Karishma Gokani Katherine Ajdukiewicz Lucinda Barrett Frances Edwards Adam Usher Mairi McLeod Su su Htwe Grace Duane Nicholas Wong Jennifer Poyner Jenni Crane Ollie Lloyd Emma Chisholm Ildiko Kustos Sam Sutton M. Estee Torok Isobel Ramsay Monica Ivan Joshua York Jennifer Ansett Maithili Varadarajan Priya Sekhon James Cruise Shivani Kanabar Mirella Ling Charlotte Milne Jayanta Sarma Aline Wilson Lynn Urquhart Sahar Eldirdiri Leila White Jody Aberdein Phillip Simpson Hnin Hay Mar Keying Tan Eint Shwe Zin thein Mahmoud Aziz Anthony Cadwgan Natasha Weston Salman Zeb Angela Houston Louise Wootton Iona Willingham Aimee Johnson Ashley Horsley Eamonn Trainor Olivier Gaillemin Nicholas J Norton Katie Cheung Megan Duxbury Emilie Bellhouse Helena Brezovjakova Kanitkar Tanmay Alexsander Dawidziuk Razan Saman Hugh Adler Elshadai Ejere Yiwen Soo Wendy Beadles Heather Sturgeon Brodie Cameron David Chadwick Ben Tomlinson Claire McGoldrick Katie McDowell Mpho Molosiwa Katherine FlackAdrian Kennedy Phoebe Cross Fay Perry Vithusha Inpadhas Sarathy Selvam Vhairi Bateman Henry Wu Monika Pasztor Ajanthiha Karunakaran Basma Soliman Andrew Blanshard Harish Reddy Helen Chesterfield Ben Schroeder Tee Keat Teoh Sathyavani Subbarao Caryn RosmarinLucy Bell Emma McGuire Robert Serafino Ishaan Bhide Karanjeet Sagoo Indran Balakrishnan Kajal Patel Barzo Faris Graeme Calver Ricky Singh Hazel Sanghvi Mohamed Eltayeb Rathur Haris
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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). 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Teoh</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Sathyavani Subbarao</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Caryn RosmarinLucy Bell</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Emma McGuire</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Robert Serafino</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ishaan Bhide</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" 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Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR)

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