Glimåker M, et al. - Authors performed this study to evaluate the effect on outcome of adherence to European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), and Swedish guidelines regarding neuroimaging before Lumbar puncture (LP). In acute bacterial meningitis (ABM), adherence to Swedish guidelines seemed associated with decreased mortality and increased favorable outcome in contrast to adherence to ESCMID or IDSA recommendations. They recommend not considering impaired mental status and immunocompromised state as indications for neuroimaging before LP in patients with suspected ABM.

Methods

• For this study, the cohort comprised 815 adult ABM patients in Sweden registered prospectively between 2008-2015.
• In-hospital mortality was assessed as primary endpoint.
• Secondary endpoint was favorable outcome at 2-6 months follow-up.

Results

• In accordance to Swedish, ESCMID and IDSA guidelines, indications for neuroimaging before LP were identified in 7%, 32% and 65%, respectively.
• If Swedish guidelines were followed, the adjusted odds ratio (aOR) was 0.48 (95% CI: 0.26-0.89) for mortality and 1.52 (1.08-2.12) for favorable outcome.
• ESCMID guideline adherence led to aOR of 0.68 (0.38-1.23) for mortality and 1.05 (0.75-1.47) for favorable outcome.
• Following IDSA recommendations led to aOR of 1.09 (0.61-1.95) for mortality and 0.59 (0.42-0.82) for favorable outcome.
• In this study, performing prompt vs. neuroimaging preceded LP seemed related with aOR of 0.37 (0.18-0.76) for mortality and 2.12 (CI: 1.49-3.03) for favorable outcome.
• Regardless of mental status and immunosuppression, there appeared beneficial effect of prompt LP.