QJM Advance Access originally published online on March 10, 2005
QJM 2005 98(4):291-298; doi:10.1093/qjmed/hci047
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Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis
From the 1Department of Medicine, University of Western Ontario, London, and 2Department of Medicine, Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
Received 1 October 2004 and in revised form 14 January 2005
Background: Bacterial meningitis continues to cause high mortality. Few studies address the possible association between this mortality and antibiotic administration delays.
Aim: To determine whether delays in antibiotic administration are associated with mortality from bacterial meningitis, and to identify inappropriate diagnostic–treatment sequences leading to such delays.
Design: Retrospective case record study.
Methods: We reviewed 123 cases of adult acute bacterial meningitis in 119 patients aged 
16 years admitted to hospital from January 1990 to March 2002, using multivariate regression analysis to assess the association between meningitis mortality and door-to-antibiotic time (the time elapsed between emergency room presentation and antibiotics administration).
Results: The case fatality rate was 13% (16/123). Adjusted odds ratios (OR) for mortality were: 8.4 (95%CI 1.7–40.9) for door-to-antibiotic time >6 h; 39.4 (95%CI 4.3–358.1) for afebrility at presentation; and 12.6 (95%CI 2.2–72.0) for severely impaired mental status at presentation. Factors associated with a door-to-antibiotic time of >6 h were: (i) failure to administer antibiotics prior to transfer from another institution (OR 21.8); (ii) the diagnostic–treatment sequence: head CT then lumbar puncture, then antibiotics (OR 5.6); and (iii) the absence of the classic meningitis triad (OR 4.9).
Discussion: There is an independent incremental association between delays in administrating antibiotics and mortality from adult acute bacterial meningitis. Inappropriate diagnostic–treatment sequences were significant predictors of such treatment delays.
Address correspondence to Dr N. Proulx, London Health Sciences Centre—Westminster Campus, 800 Commissioners Road East, Room 2941, London, Ontario, N6A 5W9, Canada. email: nproulx{at}uwo.ca
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