• A J Stockdale, M P Weekes, and S H Aliyu.
• Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Box 25, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. alexstockdale@doctors.org.uk
• QJM. 2011 Dec 1;104(12):1055-63.

BackgroundAcute bacterial meningitis (ABM) is a rare disease associated with severe neurological sequelae and death. Clinical features on admission may be subtle and thus delay recognition. Previous studies have shown association between early administration of antibiotics and favourable outcomes.AimTo examine the presenting clinical features of patients aged >15 years with ABM admitted to a University teaching hospital. To audit investigations and treatment including lumbar puncture (LP), computed tomography (CT) and antibiotics against British Infection Association guidelines.DesignRetrospective observational audit.MethodsHospital records were reviewed for presenting clinical features and timing of CT scan, LP and antibiotics.ResultsRecords of 39 patients with ABM were reviewed. The classical triad of fever, neck stiffness and altered mental state was present on admission in only 21% of cases. LP was contraindicated in 69% of cases. Immediate LP was carried out in only 17% of those who had no contraindication. Antibiotics were administered after a median of 79 min (interquartile range 24-213 min); 65% were given within 3 h after arrival. Eighty-five percent of patients had antibiotics in accordance with local guidelines.ConclusionIn patients with ABM, the classical clinical features are uncommon on arrival to hospital and frequently evolve following admission. The majority of patients have contraindications to immediate LP. Efforts should be made to facilitate immediate LP performed in the Emergency Department when there are no contraindications. Earlier administration of antibiotics in cases of suspected ABM and close review following admission is recommended.

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