Impact of pre-hospital antibiotic therapy on mortality in invasive meningococcal disease: a propensity score study

  • Carmen CabellosEmail author
  • Ivan Pelegrín
  • Eva Benavent
  • Francesc Gudiol
  • Fe Tubau
  • Dolores Garcia-Somoza
  • Ricard Verdaguer
  • Javier Ariza
  • Pedro Fernandez Viladrich
Original Article


The role of pre-hospital antibiotic therapy in invasive meningococcal diseases remains unclear with contradictory data. The aim was to determine this role in the outcome of invasive meningococcal disease. Observational cohort study of patients with/without pre-hospital antibiotic therapy in invasive meningococcal disease attended at the Hospital Universitari de Bellvitge (Barcelona) during the period 1977–2013. Univariate and multivariate analyses of mortality, corrected by propensity score used as a covariate to adjust for potential confounding, were performed. Patients with pre-hospital antibiotic therapy were also analyzed according to whether they had received oral (group A) or parenteral antibiotics (early therapy) (group B). Five hundred twenty-seven cases of invasive meningococcal disease were recorded and 125 (24%) of them received pre-hospital antibiotic therapy. Shock and age were the risk factors independently related to mortality. Mortality differed between patients with/without pre-hospital antibiotic therapy (0.8% vs. 8%, p = 0.003). Pre-hospital antibiotic therapy seemed to be a protective factor in the multivariate analysis of mortality (p = 0.038; OR, 0.188; 95% CI, 0.013–0.882). However, it was no longer protective when the propensity score was included in the analysis (p = 0.103; OR, 0.173; 95% CI, 0.021–1.423). Analysis of the oral and parenteral pre-hospital antibiotic groups revealed that there were no deaths in early therapy group. Patients able to receive oral antibiotics had less severe symptoms than those who did not receive pre-hospital antibiotics. Age and shock were the factors independently related to mortality. Early parenteral therapy was not associated with death. Oral antibiotic therapy in patients able to take it was associated with a beneficial effect in the prognosis of invasive meningococcal disease.


Invasive meningococcal disease Antibiotic therapy Prognostic factors, pre-hospital 



C. Cabellos, F. Gudiol, and J. Ariza are members of REIPI RD12/0015. I. Pelegrin had a personal grant from IDIBELL. This study was conducted as part of our routine work. C. Cabellos and I. Pelegrin are members of ESGIB. F. Tubau is a member of CIBER de Enfermedades Respiratorias ISCIII, Madrid (Spain).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Barquet N, Domingo P, Cayla JA et al (1999) Meningococcal disease in a large urban population (Barcelona, 1987-1992). Predictors of dismal prognosis. Arch Intern Med 159:2329–2340CrossRefGoogle Scholar
  2. 2.
    Domínguez A, Cardeñosa N, Pañella H, Working Group on the Study of Meningococcal Disease in Catalonia, 1990-1997 et al (2004) The case-fatality rate of meningococcal disease in Catalonia, 1990-1997. Scand J Infect Dis 36:274–227CrossRefGoogle Scholar
  3. 3.
    Stephens DS, Greenwood B, Brandtzaeg P (2007) Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 369:2196–2210CrossRefGoogle Scholar
  4. 4.
    Brighama KS, Sandorab TJ (2009) Neisseria meningitidis: epidemiology, treatment and prevention in adolescents. Curr Opin Pediatr 21:437–443CrossRefGoogle Scholar
  5. 5.
    Domingo P, Pomar V, Benito N, Coll P (2013) The changing pattern of bacterial meningitis in adult patients at a large tertiary university hospital in Barcelona, Spain (1982-2010). J Inf Secur 66(2):147–154Google Scholar
  6. 6.
    Dwilow R, Fanella S (2015) Invasive meningococcal disease in the 21st century—an update for the clinician. Curr Neurol Neurosci Rep 15:2–9CrossRefGoogle Scholar
  7. 7.
    Hahné SJM, Charlett A, Purcell B et al (2006) Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review. BMJ 332:1283–1284CrossRefGoogle Scholar
  8. 8.
    Harnden A, Ninis N, Thompson M et al (2006) Parenteral penicillin for children with meningococcal disease before hospital admission: case control study. BMJ 332:1295–1298CrossRefGoogle Scholar
  9. 9.
    PHLS Meningococcal Infections Working Group and Public Health Medicine Environmental Group (1995) Control of meningococcal disease: guidance for consultants in communicable disease control. Commun Dis Rep CDR Rev 13:189–195Google Scholar
  10. 10.
    Sudarsanam TD, Rupali P, Tharyan P, Abraham OC, Thomas K (2013) Pre-admission antibiotics for suspected cases ofmeningococcal disease. Cochrane Database Syst Rev (8. Art. No.: CD005437).
  11. 11.
    Perea-Milla E, Olalla J, Sánchez-Cantalejo E, Martos F, Matute-Cruz P, Carmona-López G, Fornieles Y, Cayuela A, García-Alegría J, the ANCA Group (2009) Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias. BMC Public Health 9:95CrossRefGoogle Scholar
  12. 12.
    Riddell T, Bullen C (2003) Pre-hospital antibiotic treatment of meningococcal disease: scope for improvement. N Z Med J 116(1182) ISSN 1175 8716Google Scholar
  13. 13.
    Nùrgaêrd B, Sùrensen HT, Jensen ES, Faber T, Schùnheyder HC, Nielsen GL (2002) Pre-hospital parenteral antibiotic treatment of meningococcal disease and case fatality: a Danish population-based cohort study. J Infect 45:144–151CrossRefGoogle Scholar
  14. 14.
    Lala HM, Mills GD, Barratt K, Bonning J, Manikkam NE, Martin D (2007) Meningococcal disease deaths and the frequency of antibiotic administration delays. J Infect 54:551e557CrossRefGoogle Scholar
  15. 15.
    Sørensen HT, Nielsen GL, Schønheyder HC, Steffensen FH, Hansen I, Sabroe S, Dahlerup JF, Hamburger H, Olsen J (1998) Outcome of pre-hospital antibiotic treatment of meningococcal disease. J Clin Epidemiol 51(9):717–721CrossRefGoogle Scholar
  16. 16.
    Al W, Brien SJO’ (1996) How long is too long? Determining the early management of meningococcal disease in Birminghan. Public Health 110:237–239CrossRefGoogle Scholar
  17. 17.
    Viladrich PF, Pallares R, Ariza J, Rufi G, Gudiol F (1986) Four days of penicillin therapy for meningococcal meningitis. Arch Intern Med 146(12):2380–2382CrossRefGoogle Scholar
  18. 18.
    Cabellos C, Pelegrín I, Benavent E, Gudiol F, Tubau F, Garcia-Somoza D, Verdaguer AJ, Fernandez-Viladrich P (2017) Invasive meningococcal disease: impact of short course therapy. A DOOR/RADAR study. J Infect 75:420–425CrossRefGoogle Scholar
  19. 19.
    Janda WM, Gaydos CH (2007) Neisseria. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA (eds) Manual of clinical microbiology, vol 1, 9th edn. ASM Press, Washington, DC, pp 601–620Google Scholar
  20. 20.
    CLSI (ed) (2017) Performance standards for antimicrobial susceptibility testing, 27th edn. CLSI supplement document M100. Clinical and Laboratory Standards Institute, WayneGoogle Scholar
  21. 21.
    Hodgetts TJ, Brett A, Castle N (1998) The early management of meningococcal disease. J Accid Emerg Med 15:72–76CrossRefGoogle Scholar
  22. 22.
    Cartwright K, Reilly S, White D, Stuart J (1992) Early treatment with parenteral penicillin in meningococcal disease. BMJ 305:143–152CrossRefGoogle Scholar
  23. 23.
    Barquet N, Domingo P, Cayla JA et al (1997) Prognostic factors in meningococcal disease: development of a bedside predictive model and scoring system. JAMA 278:491–496CrossRefGoogle Scholar
  24. 24.
    McGill F, Heyderman RS, Michael BD, Defres S, Beeching NJ, Borrow R, Glennie L, Gaillemin O, Wyncoll D, Kaczmarski E, Nadel S, Thwaites G, Cohen J, Davies NWS, Miller A, Rhodes A, Read RC, Solomon T (2016) The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 72:405e438Google Scholar
  25. 25.
    Lodder MC, Schildkamp RL, Bijlmer HA, Dankert J, Kuik DJ, Scholten RJ (1996) Prognostic indicators of the outcome of meningococcal disease: a study of 562 patients. J Med Microbiol 45(1):16–20CrossRefGoogle Scholar
  26. 26.
    Strelow V, Kolbe K, Peixoto de Miranda E, Vidal JE. (2013) Meningitis meningocócica (MM) en el Instituto de Infectologia Emílio Ribas (IIER), San Pablo-Brasil, 2006-2011: características clínico-laboratoriales, letalidad y factores asociados a mortalidad intrahospitalaria. XVI Congreso Panamericano de Infectologia. Libro de resúmenes. Santiago de Chile, 78Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Carmen Cabellos
    • 1
    Email author
  • Ivan Pelegrín
    • 1
  • Eva Benavent
    • 1
  • Francesc Gudiol
    • 1
  • Fe Tubau
    • 2
  • Dolores Garcia-Somoza
    • 2
  • Ricard Verdaguer
    • 2
  • Javier Ariza
    • 1
  • Pedro Fernandez Viladrich
    • 1
  1. 1.Infectious Diseases Service, IDIBELL-Hospital Universitari de BellvitgeUniversitat de Barcelona, L’Hospitalet de LlobregatBarcelonaSpain
  2. 2.Microbiology Service, IDIBELL-Hospital Universitari de BellvitgeUniversitat de Barcelona, L’Hospitalet de LlobregatBarcelonaSpain

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