Clinical Practice Guidelines: Bacterial Meningitis

CLINICAL PRACTICE GUIDELINES (FULL LIST)

Bacterial Meningitis

Suspected Community-Acquired Meningitis Clinical Practice Guideline (CPG)

Community-acquired meningitis is a rare but serious and possibly fatal infection of the meninges/brain and can be caused by viruses or bacteria. The bacteria most often implicated in community-acquired meningitis include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Complications that can occur from the infection include seizures, hearing loss, and developmental delay. At the time of writing this CPG, there is evidence to suggest that administration of steroids can reduce morbidity (including hearing loss) in adults and children with H.influenzae meningitis, and in adults with S.pneumoniae meningitis. The guidelines presented here reflect recommendations from the Infectious Diseases Society of America Practice Guidelines for the Management of Bacterial Meningitis. They were developed with the express intent of optimizing patient outcomes through the provision of care that is evidence-based and of the highest quality.

Community onset meningitis guidelines team:

  • Infectious diseases: Sophie Katz
  • Hospital medicine: Lauren Starnes and Charlotte Brown
  • Audiology: Liz West Ellis
  • Critical care: Michael Wolf
  • Emergency medicine: Barron Frazier
  • Otolaryngology: Frank Virgin
  • Neurology: Richard Carozza and Lindsay Pagano

 

Health Equity Considerations:

The literature supports that Black and/or Hispanic patients receive fewer antibiotics than their White counterparts. As bacterial meningitis sometimes presents due to untreated ear or sinus infections, it’s possible that these groups may have a higher incidence of bacterial meningitis. Therefore, standardizing the diagnostic process and management of bacterial meningitis is imperative. Additionally, one of the most common adverse events associated with bacterial meningitis is hearing impairment, and there is currently no way to predict which patients will have this outcome. Standardizing the practice of audiology referrals will ensure that each patient with bacterial meningitis is followed for the appropriate amount of time with serial audiologic exams. This practice will make sure that any child with concerns for hearing impairment has the necessary resources and services required so they do not fall further behind.

 

Tracking metrics:

  1. For patients with an ICD-10 code for “Meningitis due to Haemophilus influenzae” (G00.0), what percentage had dexamethasone started within the first 12 hours?
    1. Goal: Close to 100%
  2. What percentage of patients with an ICD-10 code for “Pneumococcal meningitis” (G00.1) received dexamethasone?
    1. Pre/post comparison
  3. Of patients with an ICD-10 code for “Bacterial meningitis, unspecified” (G00.9) and upon further chart review did not have pneumococcal or H. influenzae meningitis, what percentage received steroids for >24H?
    1. Goal: 0%
  4. Adverse outcomes of steroids

References:

  1. Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;2015(9):CD004405. Published 2015 Sep 12. doi:10.1002/14651858.CD004405.pub5
  2. Costerus JM, Brouwer MC, Sprengers MES, Roosendaal SD, van der Ende A, van de Beek D. Cranial Computed Tomography, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study. Clin Infect Dis. 2018;67(6):920-926. doi:10.1093/cid/ciy200
  3. Joffe AR. Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A Review. Journal of Intensive Care Medicine. 2007;22(4):194-207. doi:10.1177/0885066607299516
  4. McGuire JL, Tuite NV, Swami SK, Avery RA. Assessment of Diagnostic Yield of Nonculture Infection Testing on Cerebrospinal Fluid in Immune-Competent Children. JAMA Netw Open. 2019;2(7):e197307. Published 2019 Jul 3. doi:10.1001/jamanetworkopen.2019.7307
  5. Nigrovic LE, Kuppermann N, Macias CG, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007;297(1):52-60. doi:10.1001/jama.297.1.52
  6. Overview: Meningitis (bacterial) and meningococcal septicaemia in under 16s: Recognition, diagnosis and management: Guidance. NICE. June 10, 2010. Accessed July 18, 2023. https://www.nice.org.uk/guidance/cg102.
  7. Tunkel AR, et. al., Practice Guidelines for the Management of Bacterial Meningitis, Clinical Infectious Diseases, Volume 39, Issue 9, 1 November 2004, Pages 1267–1284, https://doi.org/10.1086/425368