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Community-acquired bacterial meningitis in adults: emergency department management protocol

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Abstract

Acute bacterial meningitis (ABM) is a rare but disabling infectious condition that requires a performant multidisciplinary management approach. Between 70 and 90 adult patients are diagnosed with community-acquired ABM in Belgium annually, and reported case fatality rates range from 17 to 40%. The currently available guidelines provide evidence-based guidance on how to manage this disease. However, these guidelines do not translate the evidence to the daily practice at the emergency department in a Belgian healthcare context. We created a taskforce in University Hospitals Leuven consisting of experts with complementary expertise in managing this disease: neurology, neurosurgery, intensive care medicine, microbiology and infectious diseases. The taskforce agreed upon a flowchart containing seven management steps encompassing all relevant phases in emergency ABM management. In addition to the focus on timely and adequate initiation of antimicrobial treatment, the flowchart and protocol also provide guidance on practical hurdles such as how to assess the safety of performing a lumbar puncture and when to refer patients to the intensive care department. This protocol was implemented in University Hospitals Leuven and fosters inter-disciplinary coordination of ABM care.

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Abbreviations

ABM:

Acute bacterial meningitis

aPTT:

Activated partial thromboplastin time

CRP:

C-reactive protein

CT:

Computed tomography

CSF:

Cerebrospinal fluid

DIC:

Diffuse intravascular coagulation

EFNS:

European Federation of Neurological Societies

ESCMID:

European Society of Clinical Microbiology and Infectious Diseases

GCS:

Glasgow Coma Scale

ICP:

Intracranial pressure

ICU:

Intensive care unit

INR:

International normalized ratio

ISDA:

Infectious Diseases Society of America

IM:

Intramuscular

LP:

Lumbar puncture

PCR:

Polymerase chain reaction

PT:

Prothrombin time

WBC:

White blood cell

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Authors and Affiliations

  1. Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    I. Smets & B. Dubois

  2. Department of Emergency Medicine, University Hospitals Leuven, 3000, Leuven, Belgium

    S. Verelst

  3. Department of Intensive Care Medicine, University Hospitals Leuven, 3000, Leuven, Belgium

    G. Meyfroidt

  4. Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, 3000, Leuven, Belgium

    E. Van Wijngaerden

  5. Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, 3000, Leuven, Belgium

    A. Wilmer

  6. Department of Neurosurgery, University Hospitals Leuven, 3000, Leuven, Belgium

    J. van Loon

  7. Department of Laboratory Medicine, University Hospitals Leuven, 3000, Leuven, Belgium

    K. Lagrou

  8. Laboratory for Neuroimmunology, Department of Neurosciences, KU Leuven, Herestraat 49 bus 1022, 3000, Leuven, Belgium

    I. Smets

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  1. I. Smets
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Smets, I., Verelst, S., Meyfroidt, G. et al. Community-acquired bacterial meningitis in adults: emergency department management protocol. Acta Neurol Belg 120, 1033–1043 (2020). https://doi.org/10.1007/s13760-020-01428-w

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