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Bacterial Meningitis

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Key Resources English (5) French All (5)

CSF interpretation

Visit

The Royal Children's Hospital Melbourne

Guideline to help with the interpretation of CSF results for the purpose of diagnosing or excluding meningitis.

Lumbar puncture

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The Royal Children's Hospital Melbourne

Guideline for performing lumbar puncture.

Meningitis - encephalitis

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The Royal Children's Hospital Melbourne

Guideline for the assessment and management of meningitis-encephalitis.

Management of Bacterial Meningitis in Children and Young People

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Meningitis Research Foundation

Flowchart of management of bacterial meningitis in children and young people, incorporating NICE Bacterial Meningitis and Meningococcal Septicaemia Guideline CG102.

Early Recognition of Meningitis and Septicaemia

Visit

Royal College of Nursing, Meningitis Research Foundation

Guidance for front line nurses on the early recognition of meningitis and sepsis (what to look for).

CSF interpretation

Visit

The Royal Children's Hospital Melbourne

Guideline to help with the interpretation of CSF results for the purpose of diagnosing or excluding meningitis.

Lumbar puncture

Visit

The Royal Children's Hospital Melbourne

Guideline for performing lumbar puncture.

Meningitis - encephalitis

Visit

The Royal Children's Hospital Melbourne

Guideline for the assessment and management of meningitis-encephalitis.

Management of Bacterial Meningitis in Children and Young People

Visit

Meningitis Research Foundation

Flowchart of management of bacterial meningitis in children and young people, incorporating NICE Bacterial Meningitis and Meningococcal Septicaemia Guideline CG102.

Early Recognition of Meningitis and Septicaemia

Visit

Royal College of Nursing, Meningitis Research Foundation

Guidance for front line nurses on the early recognition of meningitis and sepsis (what to look for).

Clinical guidelines English (4) French All (4)

Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

Visit

National Institute for Health and Care Excellence

Guideline covering recognising, diagnosing and managing bacterial meningitis and meningococcal septicaemia in babies, children and young people under 16.

Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age

Visit

Le Saux N; Canadian Paediatric Society, Infectious Diseases and ImmunizationC...

Statement reviewing the current epidemiology of bacterial meningitis in children beyond the neonatal period and provide guidelines for the empirical management of suspected bacterial meningitis in Canadian children.

Infants and Children: Acute Management of Bacterial Meningitis: Clinical Practice Guideline

Visit

NSW Health

Clinical practice guidelines for the acute management of infants and children with bacterial meningitis.

Practice guidelines for the management of bacterial meningitis

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Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ

Practice guidelines to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis.

Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

Visit

National Institute for Health and Care Excellence

Guideline covering recognising, diagnosing and managing bacterial meningitis and meningococcal septicaemia in babies, children and young people under 16.

Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age

Visit

Le Saux N; Canadian Paediatric Society, Infectious Diseases and ImmunizationC...

Statement reviewing the current epidemiology of bacterial meningitis in children beyond the neonatal period and provide guidelines for the empirical management of suspected bacterial meningitis in Canadian children.

Infants and Children: Acute Management of Bacterial Meningitis: Clinical Practice Guideline

Visit

NSW Health

Clinical practice guidelines for the acute management of infants and children with bacterial meningitis.

Practice guidelines for the management of bacterial meningitis

Visit

Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ

Practice guidelines to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis.

Summaries of systematic reviews English (4) French All (4)

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Cochrane Summary: Fluids for people with acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Summary: Corticosteroids for bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Summary: Can a Clinical Prediction Rule Reliably Predict Pediatric Bacterial Meningitis?

Visit

Ostermayer DG, Koyfman A

Objective: To determine if a clinical prediction rule can reliably determine which children should be hospitalized and treated with intravenous antibiotics for bacterial meningitis.

Summary: In children with bacterial meningitis, does the addition of dexamethasone to an antibiotic treatment regimen result in a better clinical outcome than the antibiotic regimen alone?: Part A: Evidence-based answer and summary

Visit

Fox JL

Objective: To determine the efficacy of adjuvant dexamethasone therapy in paediatric bacterial meningitis.

Systematic reviews English (10) French All (10)

Review: Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

Visit

April MD, Long B, Koyfman A

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

Review: Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Visit

Dorsett M, Liang SY

Objective: This review discusses the clinical signs and symptoms that should lead emergency physicians to consider CNS infection, paying particular attention to the sensitivity and specificity of different clinical findings at the bedside. Subsequently, the diagnostic workup and management of patients for whom there is high clinical suspicion for CNS infection is discussed.

Cochrane Systematic Review: Fluid therapy for acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Systematic Review: Corticosteroids for acute bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Review: Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines

Visit

Glimker M, Johansson B, Bell M, Ericsson M, Blckberg J, Brink M, Lindquist L,...

Objective: Revised Swedish guidelines regarding early lumbar puncture (LP) are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed.

Systematic Review: Does this child have bacterial meningitis? A systematic review of clinical prediction rules for children with suspected bacterial meningitis

Visit

Kulik DM, Uleryk EM, Maguire JL

Objective: Our aim was to systematically identify and review the quality and performance of published clinical prediction rules (CPRs) for children with suspected bacterial meningitis.

Systematic Review: Meta-analysis of bacterial meningitis score validation studies

Visit

Nigrovic LE, Malley R, Kuppermann N

Objective: The study objective of the present work was to calculate the performance of the Bacterial Meningitis Score by performing a meta-analysis of all published validation studies.

Systematic Review: Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis

Visit

Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S

Objective: Our study's purpose was to assess the utility of CSF lactate in differentiating bacterial meningitis from aseptic meningitis.

Systematic Review: Clinical features suggestive of meningitis in children: a systematic review of prospective data

Visit

Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T

Objective: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis.

Review: Lumbar puncture and brain herniation in acute bacterial meningitis: a review

Visit

Joffe AR

Objective: There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy.

Review: Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

Visit

April MD, Long B, Koyfman A

Objective: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis.

Review: Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Visit

Dorsett M, Liang SY

Objective: This review discusses the clinical signs and symptoms that should lead emergency physicians to consider CNS infection, paying particular attention to the sensitivity and specificity of different clinical findings at the bedside. Subsequently, the diagnostic workup and management of patients for whom there is high clinical suspicion for CNS infection is discussed.

Cochrane Systematic Review: Fluid therapy for acute bacterial meningitis

Visit

Maconochie IK, Bhaumik S

Objective: To evaluate treatment of acute bacterial meningitis with differing volumes of initial fluid administration (up to 72 hours after first presentation) and the effects on death and neurological sequelae.

Cochrane Systematic Review: Corticosteroids for acute bacterial meningitis

Visit

Brouwer MC, McIntyre P, Prasad K, Van de Beek D

Objective: To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis.

Review: Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines

Visit

Glimker M, Johansson B, Bell M, Ericsson M, Blckberg J, Brink M, Lindquist L,...

Objective: Revised Swedish guidelines regarding early lumbar puncture (LP) are presented, and the background documentation and reasons for omitting impaired consciousness, new onset seizures, and immunocompromised state as contraindications to LP are discussed.

Systematic Review: Does this child have bacterial meningitis? A systematic review of clinical prediction rules for children with suspected bacterial meningitis

Visit

Kulik DM, Uleryk EM, Maguire JL

Objective: Our aim was to systematically identify and review the quality and performance of published clinical prediction rules (CPRs) for children with suspected bacterial meningitis.

Systematic Review: Meta-analysis of bacterial meningitis score validation studies

Visit

Nigrovic LE, Malley R, Kuppermann N

Objective: The study objective of the present work was to calculate the performance of the Bacterial Meningitis Score by performing a meta-analysis of all published validation studies.

Systematic Review: Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis

Visit

Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S

Objective: Our study's purpose was to assess the utility of CSF lactate in differentiating bacterial meningitis from aseptic meningitis.

Systematic Review: Clinical features suggestive of meningitis in children: a systematic review of prospective data

Visit

Curtis S, Stobart K, Vandermeer B, Simel DL, Klassen T

Objective: To seek evidence supporting accuracy of clinical features of pediatric bacterial meningitis.

Review: Lumbar puncture and brain herniation in acute bacterial meningitis: a review

Visit

Joffe AR

Objective: There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy.

Key studies English (11) French All (11)

Key study: Cranial CT, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study

Visit

Costerus JM, Brouwer MC, Sprengers MES, Roosendaal SD, van der Ende A, van de...

Objective: In 2006, we started a prospective cohort study to identify and characterize host genetic traits and bacterial genetic factors controlling occurrence and outcome of bacterial meningitis (MeninGene). Here, we report data from this study, focusing on complications of LP in adults with community-acquired bacterial meningitis and the role of cranial CT prior to LP.

Key study: Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines

Visit

Glimker M, Sjlin J, kesson S, Naucler P

Objective: The aim was 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 LP.

Key study: Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines

Visit

Salazar L, Hasbun R

Objective: The main objectives of this study were to identify the adherence of clinicians to IDSA guidelines regarding cranial imaging in patients with CAM, to evaluate the clinical and prognostic differences between those patients with and without an indication for cranial imaging, and to assess the clinical impact in management in those with abnormal intracranial findings with or without altered mental status as their sole indication for imaging.

Key study: Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture

Visit

Glimker M, Johansson B, Grindborg , Bottai M, Lindquist L, Sjlin J

Objective: Despite guideline emphasis on early treatment, performing CT prior to LP implies a risk of delayed treatment and unfavorable outcome. Therefore, Swedish guidelines were revised in 2009, deleting impaired mental status as a contraindication for LP without prior CT scan. The aim of the present study was to evaluate the guideline revision.

Key study: Prevalence and predictors of bacterial meningitis in young infants with Fever without a source

Visit

Martinez E, Mintegi S, Vilar B, Martinez MJ, Lopez A, Catediano E, Gomez B

Objective: Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors.

Key study: Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study

Visit

Sadarangani M, Scheifele DW, Halperin SA, Vaudry W, Le Saux N, Tsang R, Betti...

Objective: The objectives of this study were to describe the outcomes following invasive meningococcal disease (IMD) in a prospective cohort of children and adults, and to identify specific risk factors for death and development of neurological and nonneurological complications.

Key study: Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

Visit

Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, Casado...

Objective: To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.

Key study: Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis

Visit

Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schem...

Objective: To validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.

Key study: Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment

Visit

Kanegaye JT, Soliemanzadeh P, Bradley JS

Objective: We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.

Key study: Cerebrospinal fluid findings in aseptic versus bacterial meningitis

Visit

Negrini B, Kelleher KJ, Wald ER

Objective: To assess 1) the characteristics of the CSF differential in aseptic versus bacterial meningitis, 2) the influence of duration of illness on the CSF differential, and 3) the role of the CSF differential in discriminating between aseptic versus bacterial meningitis.

Key study: A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children

Visit

Schaad UB, Suter S, Gianella-Borradori A, Pfenninger J, Auckenthaler R, Berna...

Objective: To compare ceftriaxone with cefuroxime for the treatment of meningitis, we conducted a study in which 106 children with acute bacterial meningitis were randomly assigned to receive either ceftriaxone (100 mg per kilogram of body weight per day, administered intravenously once daily; n = 53) or cefuroxime (240 mg per kilogram per day, administered intravenously in four equal doses; n = 53).

Key study: Cranial CT, Lumbar Puncture, and Clinical Deterioration in Bacterial Meningitis: A Nationwide Cohort Study

Visit

Costerus JM, Brouwer MC, Sprengers MES, Roosendaal SD, van der Ende A, van de...

Objective: In 2006, we started a prospective cohort study to identify and characterize host genetic traits and bacterial genetic factors controlling occurrence and outcome of bacterial meningitis (MeninGene). Here, we report data from this study, focusing on complications of LP in adults with community-acquired bacterial meningitis and the role of cranial CT prior to LP.

Key study: Lumbar Puncture Performed Promptly or After Neuroimaging in Acute Bacterial Meningitis in Adults: A Prospective National Cohort Study Evaluating Different Guidelines

Visit

Glimker M, Sjlin J, kesson S, Naucler P

Objective: The aim was 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 LP.

Key study: Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines

Visit

Salazar L, Hasbun R

Objective: The main objectives of this study were to identify the adherence of clinicians to IDSA guidelines regarding cranial imaging in patients with CAM, to evaluate the clinical and prognostic differences between those patients with and without an indication for cranial imaging, and to assess the clinical impact in management in those with abnormal intracranial findings with or without altered mental status as their sole indication for imaging.

Key study: Adult bacterial meningitis: earlier treatment and improved outcome following guideline revision promoting prompt lumbar puncture

Visit

Glimker M, Johansson B, Grindborg , Bottai M, Lindquist L, Sjlin J

Objective: Despite guideline emphasis on early treatment, performing CT prior to LP implies a risk of delayed treatment and unfavorable outcome. Therefore, Swedish guidelines were revised in 2009, deleting impaired mental status as a contraindication for LP without prior CT scan. The aim of the present study was to evaluate the guideline revision.

Key study: Prevalence and predictors of bacterial meningitis in young infants with Fever without a source

Visit

Martinez E, Mintegi S, Vilar B, Martinez MJ, Lopez A, Catediano E, Gomez B

Objective: Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors.

Key study: Outcomes of invasive meningococcal disease in adults and children in Canada between 2002 and 2011: a prospective cohort study

Visit

Sadarangani M, Scheifele DW, Halperin SA, Vaudry W, Le Saux N, Tsang R, Betti...

Objective: The objectives of this study were to describe the outcomes following invasive meningococcal disease (IMD) in a prospective cohort of children and adults, and to identify specific risk factors for death and development of neurological and nonneurological complications.

Key study: Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

Visit

Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, Casado...

Objective: To compare the performance of two of these CDRs for children: the Bacterial Meningitis Score (BMS) and the Meningitest.

Key study: Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis

Visit

Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schem...

Objective: To validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.

Key study: Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment

Visit

Kanegaye JT, Soliemanzadeh P, Bradley JS

Objective: We conducted a retrospective review of children with bacterial meningitis to describe the rate at which parenteral antibiotic pretreatment sterilizes CSF cultures.

Key study: Cerebrospinal fluid findings in aseptic versus bacterial meningitis

Visit

Negrini B, Kelleher KJ, Wald ER

Objective: To assess 1) the characteristics of the CSF differential in aseptic versus bacterial meningitis, 2) the influence of duration of illness on the CSF differential, and 3) the role of the CSF differential in discriminating between aseptic versus bacterial meningitis.

Key study: A comparison of ceftriaxone and cefuroxime for the treatment of bacterial meningitis in children

Visit

Schaad UB, Suter S, Gianella-Borradori A, Pfenninger J, Auckenthaler R, Berna...

Objective: To compare ceftriaxone with cefuroxime for the treatment of meningitis, we conducted a study in which 106 children with acute bacterial meningitis were randomly assigned to receive either ceftriaxone (100 mg per kilogram of body weight per day, administered intravenously once daily; n = 53) or cefuroxime (240 mg per kilogram per day, administered intravenously in four equal doses; n = 53).