Adherence to standard of care in the diagnosis and treatment of suspected bacterial meningitis

Am J Med Qual. 2015 Nov-Dec;30(6):539-42. doi: 10.1177/1062860614545778. Epub 2014 Aug 1.


Acute bacterial meningitis (ABM) is a rare but deadly neurological emergency. Accordingly, Infectious Diseases Society of America (IDSA) guidelines summarize current evidence into a straightforward algorithm for its management. The goal of this study is to evaluate the overall compliance with these guidelines in patients with suspected ABM. A retrospective cross-sectional study was conducted of adult patients who underwent lumbar puncture for suspected ABM to ascertain local adherence patterns to IDSA guidelines for bacterial meningitis. Primary outcomes included appropriate utilization of neuroimaging, blood cultures, antibiotics, corticosteroids, and lumbar puncture. In all, 160 patients were included in the study. Overall IDSA compliance was only 0.6%. Neuroimaging and blood cultures were appropriately utilized in 54.3% and 47.5% of patients, respectively. Steroids and antibiotics were appropriately administered in only 7.5% and 5.6% of patients, respectively. Adherence to IDSA guidelines is poor. Antibiotic choice is often incorrect, corticosteroids are rarely administered, and there is an overutilization of neuroimaging.

Keywords: adherence; bacterial meningitis; guidelines; standard of care.

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Blood Culture
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hospitals, Teaching / statistics & numerical data*
  • Humans
  • Male
  • Meningitis, Bacterial / diagnosis*
  • Meningitis, Bacterial / diagnostic imaging
  • Meningitis, Bacterial / drug therapy*
  • Middle Aged
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Spinal Puncture
  • Tomography, X-Ray Computed


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents