Longer than 2 hours to antibiotics is associated with doubling of mortality in a multinational community-acquired bacterial meningitis cohort
Language English Country Great Britain, England Media electronic
Document type Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review
PubMed
35027606
PubMed Central
PMC8758708
DOI
10.1038/s41598-021-04349-7
PII: 10.1038/s41598-021-04349-7
Knihovny.cz E-resources
- MeSH
- Anti-Bacterial Agents administration & dosage MeSH
- Time-to-Treatment * MeSH
- Time Factors MeSH
- Community-Acquired Infections complications drug therapy mortality MeSH
- Humans MeSH
- Meningitis, Bacterial complications drug therapy mortality MeSH
- Nervous System Diseases epidemiology etiology MeSH
- Observational Studies as Topic MeSH
- Retrospective Studies MeSH
- Propensity Score MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
- Systematic Review MeSH
- Geographicals
- Australia epidemiology MeSH
- United Kingdom epidemiology MeSH
- Sweden epidemiology MeSH
- Names of Substances
- Anti-Bacterial Agents MeSH
To optimally define the association between time to effective antibiotic therapy and clinical outcomes in adult community-acquired bacterial meningitis. A systematic review of the literature describing the association between time to antibiotics and death or neurological impairment due to adult community-acquired bacterial meningitis was performed. A retrospective cohort, multivariable and propensity-score based analyses were performed using individual patient clinical data from Australian, Danish and United Kingdom studies. Heterogeneity of published observational study designs precluded meta-analysis of aggregate data (I2 = 90.1%, 95% CI 71.9-98.3%). Individual patient data on 659 subjects were made available for analysis. Multivariable analysis was performed on 180-362 propensity-score matched data. The risk of death (adjusted odds ratio, aOR) associated with treatment after two hours was 2.29 (95% CI 1.28-4.09) and increased substantially thereafter. Similarly, time to antibiotics of greater than three hours was associated with an increase in the occurrence of neurological impairment (aOR 1.79, 95% CI 1.03-3.14). Among patients with community-acquired bacterial meningitis, odds of mortality increase markedly when antibiotics are given later than two hours after presentation to the hospital.
3rd Faculty of Medicine Charles University and University Hospital Bulovka Prague Czech Republic
College of Medicine and Dentistry James Cook University Discovery Drive Douglas QLD 4814 Australia
Department of Infectious Diseases Aalborg University Hospital Mølleparkvej 4 9000 Aalborg Denmark
Hennepin County Medical Center University of Minnesota Minneapolis USA
Institute of Infection and Global Health University of Liverpool Liverpool L69 7BE UK
The Townsville University Hospital Angus Smith Drive Douglas QLD 4814 Australia
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