Lumbar puncture in the management of adults with suspected bacterial meningitis - a survey of practice

University of Bristol, Bristol, England, United Kingdom
The Journal of infection (Impact Factor: 4.44). 06/2006; 52(5):315-9. DOI: 10.1016/j.jinf.2005.07.025
Source: PubMed


Assess the use of lumbar puncture (LP) in the management of suspected community acquired bacterial meningitis in adults.
A questionnaire was sent to secondary care clinicians (excluding junior house officers) in general internal and emergency medicine at three acute NHS healthcare trusts in the south west of England. The questionnaire recorded the experience of the clinician and asked questions related to case scenarios representing common presentations of bacterial meningitis or meningococcal disease.
The response rate was 42% (108/260). Nearly all of the respondents (91%) reported regularly managing patients with suspected meningitis. Most respondents considered that (i) brain computerised tomography (CT) was necessary prior to undertaking LP (78%, 60/77), (ii) LP was a useful first line investigation in a patient with meningococcal shock.(80%, 84/105), (iii) LP could be performed safely in a man with a falling level of consciousness if the CT brain was normal (89/106, 84%). Early antibiotic administration was considered important, other management priorities such as oxygen therapy, volume resuscitation, and critical care involvement were not emphasised.
Reported clinical practice in the investigation and management of meningitis in adults is not in line with current published guidance. Efforts to target interventions that promote consensus in practice are needed.

Download full-text


Available from: James Stuart, Apr 23, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Free radical grafting of acrylic acid (AA) on poly(vinilydenefluoride) (PVDF) porous membranes was studied at 65°C using supercritical carbon dioxide (scCO2) as a solvent and delivery agent. The process was initiated by the thermal decomposition of benzoylperoxide (BPO).Spectroscopic analyses confirmed the presence of poly(AA) chains linked to treated membranes. The mass fraction of grafted AA increased with grafting time and BPO concentration while it decreased when the density of the fluid phase was enhanced. A not-monotonic trend was obtained when the effect of the initial AA concentration was studied. The grafting process was accompanied by a reduction of the crystallinity of the PVDF matrix.Flow measurements and caffeine release experiments performed using PVDF membranes with proper grafting degree exhibited a pH dependent behaviour.
    Journal of Supercritical Fluids The 06/2012; 66. DOI:10.1016/j.supflu.2011.09.004 · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bacterial meningitis is a condition in which inflammation plays a role in disease resolution and also contributes to morbidity. Markers of inflammation may be used to aid in establishing diagnoses and prognoses. Medical management aimed at modulating the inflammatory response with broadly active, potent glucocorticosteroids has proved useful as an adjunct to antimicrobial therapy in selected patient populations. Basic immunobiologists, in describing components of the immune response that define its features of specificity, recognition, activation, regulation and tolerance induction have opened the door for the development of agents with focused activity that permit selective immunomodulation. New insights regarding management may result from a better understanding of the role of inflammation in bacterial meningitis. Insights have been gained from recent basic and clinical scientific investigations that examine the components and consequences of inflammation in animal models and patients with bacterial meningitis. This issue of Current Opinion in Neurology addresses recent reports that illustrate aspects of the inflammatory responses associated with bacterial meningitis that emphasize the need for early diagnosis, and contribute to prognosis assessment, and reviews the investigations that may predict the next steps in the evolution of clinical management.
    Current Opinion in Neurology 09/2006; 19(4):369-73. DOI:10.1097/01.wco.0000236616.97333.44 · 5.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors who have limited experience of these conditions. In contrast to paediatric practice, data from industrialized countries with regard to current hospital management practice are lacking. To examine whether current practice meets recommended standards in hospital management of community-acquired bacterial meningitis and meningococcal septicaemia among adults. National audit of medical records. We conducted a survey of all patients with acute bacterial meningitis and meningococcal septicaemia admitted to 18 randomly selected acute hospitals in England and Wales between 1 January 2000 and 31 December 2001. All stages of care, including pre-hospital management, initial hospital assessment, record keeping, and ongoing hospital and public health management, were assessed. We identified 212 cases of bacterial meningitis and meningococcal septicaemia; 190 cases remained in the final analysis. Clinical record keeping did not meet acceptable standards in 33% of cases. Parenteral antibiotics were given within 1 h of hospital arrival in 56% of cases, increasing to 79% among those with an initial differential diagnosis that included bacterial meningitis or meningococcal septicaemia. A full severity of illness assessment was made in 27%. The quality of clinical practice varied widely between hospitals. This was most pronounced in the timeliness of consultant review (p < 0.0005). The quality of adult clinical practice for bacterial meningitis and meningococcal septicaemia needs improvement. This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries.
    QJM: monthly journal of the Association of Physicians 11/2006; 99(11):761-9. DOI:10.1093/qjmed/hcl111 · 2.50 Impact Factor
Show more