Table 1.
Characteristics of studies of community-acquired bacterial meningitis that include time to antibiotic data.
| Study | Site | Design | Na | Setting | Ageb | Main bacterial pathogensc | Outcomes measured | Mortality (%) | Risks of delay in antibiotics (95% confidence intervals)d |
|---|---|---|---|---|---|---|---|---|---|
| Studies reporting risk associated with time to antibiotics | |||||||||
| Bodilsen 201618 | Denmark 1998–2014 | Regional retrospective | 173 | General | 58 | S. pneumoniae 55%, N. meningitidis 21%, other bacteria 24% | In-hospital mortality and neurological impairment | 23.3 | Mortality TTA > 6 h RR 1.6 (0.8–3.2) |
| Køster-Rasmussen 20086 | Denmark 2002–2004 | Regional retrospective | 125 | General | 62 | S. pneumoniae 62%, N. meningitidis 9%, Listeria spp. 6%, S. aureus 5% | Death or neurological impairment at follow-up (median 30 days) | 33 | Poor outcome TTA OR/h 1.09 (1.01–1.19) |
| Auburtin 200611 | France 2001–2003 | Multicentre prospective | 156 | ICU | 56 | S. pneumoniae 100% | Mortality and neurological impairment at ICU admission and 3 months | 33 | Mortality TTA > 3 h OR 14.12 (3.93–50.9) |
| Bretonniere 201512 | France 2004–2008 | Multicentre retrospective | 157 | ICU | 41 | S. pneumoniae 56%, N. meningitidis 32% | ICU mortality, 3 month mortality and neurological impairment | 15 | Median TTA in survivors 1·6 h/3.8 non-survivors (p = 0.003) |
| Dzupova 200913 | Czech Republic 1997–2006 | Single centre prospective | 279 | General | 51 | S. pneumoniae 29%, N. meningitidis 27% , L. monocytogenes 7%, Enterobacteriaceae 4% | Mortality and neurological impairment at 6 months | 20 | Unfavourable outcome TTA > 48 h post CABM symptoms OR 2.47 (1.04–5.88) |
| Glimaker 201514 | Sweden 2005–2012 | National registry retrospective | 712 | General | 61 | S. pneumoniae 51%, N. meningitidis 12%, H. influenzae 7%, Streptococcus spp. 6% | In-hospital mortality, neurological impairment at 2–6 months post-discharge | 10 | Mortality TTA RR/h 1.13 (1.03–1.23) |
| Lepur 200715 | Croatia 1990–2004 | Single centre retrospective | 286 | General | 49 | S. pneumoniae 39%, N. meningitidis 8%, L. monocytogenes 7%, H. influenzae 6% | In-hospital mortality, neurological impairment at discharge | 22.7 | Unfavourable outcome TTA > 24 h OR 2·8 (1·13–7) |
| Proulx 200516 | Canada 1990 –2002 | Single centre retrospective | 123 | General | 54 | S. pneumoniae 56%, S. aureus 9%, N. meningitidis 9%, S. aureus 9%, L. monocytogenes 9% | In-hospital mortality | 13 | Mortality TTA > 6 h OR 8.4 (1.7–40.9) |
| Studies without calculated risk associated with time to antibiotics | |||||||||
| Abulhasan 201317 | Canada 2000–2010 | Single centre retrospective | 37 | ICU | 37 | S. pneumoniae 38%, Group A streptococci 11%, E. coli 11%, N. meningitidis 8% | Mortality and neurological impairment at 1 and 3 months | ||
| Aronin 199818 | USA 1970–1995 | Multicentre prospective | 269 | General | 57 | S. pneumoniae 48%, N. meningitidis 15%, S. aureus 9%, other streptococci 12% | In-hospital death and neurologic impairment at discharge | ||
| Bryan 198619 | USA 1979–1984 | Single centre retrospective | 14 | General | Not reported | S. pneumoniae 64%, N. meningitis 14% | Mortality in hospital, neurologic impairment at time of discharge | ||
| Fang 200020 | Taiwan 1986 –1999 | Single centre retrospective | 18 | General | 51 | Klebsiella pneumoniae 100% | In-hospital mortality, neurological impairment at discharge | ||
| Lazzarini 200821 | Italy 2002–2005 | National prospective | 322 | General | 54 | S. pneumoniae 41%, N. meningitidis 14%, CSF Gram stain positive 41% | In-hospital mortality, neurological impairment at discharge | ||
| Lu 200222 | Taiwan 1986–1999 | Single centre retrospective | 109 | General | 50 | K. pneumoniae 40%, S. pneumoniae 9%, viridans streptococci 10%, S. aureus 6% | In-hospital mortality | ||
| Milhaud 199623 | France | Single centre prospective | 39 | ICU | 67 | S. pneumoniae 36%, L. monocytogenes 23%, S. aureus 18%, K. pneumoniae 5% | In-hospital mortality | ||
| Miner 200124 | USA 1987 –1997 | Single centre retrospective | 44 | General | 47 | S. pneumoniae 41%, N. meningitidis 16%, S. aureus 14%, E. coli 9% | In-hospital mortality | ||
| Mishal 200825 | Israel 1988–1999 | Single centre retrospective | 25 | General | Not reported | S. pneumoniae 28%, N. meningitidis 28% | In-hospital mortality, neurological impairment at discharge | ||
| Stockdale 20118 | UK 2005–2010 | Single centre retrospective | 39 | General | 39 | N. meningitidis 51%, S. pneumoniae 44% | In-hospital mortality | ||
| Updated data from Bodilsen 201618 | |||||||||
| Bodilsen 20187e | Denmark 1998–2014 | Regional retrospective | 358 | General | 56.7 | S. pneumoniae 54·3%, N. meningitidis 21%, other bacteria 24·7% | In-hospital mortality and neurological impairment | 23.5 | Mortality TTA > 4 h (32%) vs. < 2 h (15%), p = 0.003 |
CABM community-acquired bacterial meningitis, TTA time to antibiotics, ICU intensive care unit, UK United Kingdom, US United States.
aNumber of adult patients with CABM.
bMean / median variously reported.
cPathogens with incidence ≥ 5%.
dMultivariate model.
eThe primary outcome of this study was associated with the timeliness of CABM diagnosis. Time to antibiotics, age, type of bacterial pathogen, in-hospital mortality and neurological impairment were among the variables collected.