Eleonore Roy, Reda Bentayeb, Marie Estelle Cariou, Myrtille Viel, Patricia Ricaud, Anne Cady, Clarisse Dupin, Florian Reizine, Boris Delange, Bertrand Boulanger, Olivier Maigre, Caroline Piau, Sophie Reissier, Rodolphe Buzele, Christian Brice, Paul Georges Reuter, Pierre Tattevin, Pierre Fillâtre
Significant delays in antibiotic administration persist for suspected meningitis. Pre-LP neuroimaging is frequently performed outside guideline indications and is associated with longer times to antibiotic initiation. Standardized protocols and audit-feedback strategies may help reduce delays in antibiotic administration for suspected ABM.
PURPOSE: Acute bacterial meningitis (ABM) is a life-threatening infection requiring rapid diagnosis and prompt antibiotic treatment. Current guidelines tend to restrict neuroimaging studies before lumbar puncture (LP), to avoid delays in antibiotic initiation. We evaluated real-world management and factors associated with delayed antibiotic administration in adults presenting to the emergency department (ED) with suspected meningitis.
METHODS: We conducted a retrospective multicenter observational study using routinely collected clinical data in four French hospitals between September 2019 and March 2025. Adult patients presenting with suspected ABM, cerebrospinal fluid pleocytosis (≥ 5 cells/mm³), and receiving antibiotic therapy were included. Factors associated with antibiotic delay were assessed using an exploratory 6-hour threshold (multivariable logistic regression) and continuous time-to-antibiotic analysis (log-normal Accelerated Failure Time [AFT] model).
RESULTS: In total, 146 patients were included, among whom 33 had confirmed ABM. Median time from ED admission to appropriate antibiotics was 385.0 [223.2-631.5] minutes overall. Only 2/33 (6.1%) ABM received antibiotics within the first hour after ED admission. Brain imaging before LP was performed in 86 (58.9%) patients, although French guidelines criteria were met in only 51/145 (35.2%) of cases. In multivariable analyses, pre-LP imaging was independently associated with a higher risk of delay beyond 6 h (OR 2.75 [1.26-6.00]; p = 0.012) and a 61% increase in median time to antibiotics (Time Ratio = 1.61 [1.04-2.50]; p = 0.032).
CONCLUSION: Significant delays in antibiotic administration persist for suspected meningitis. Pre-LP neuroimaging is frequently performed outside guideline indications and is associated with longer times to antibiotic initiation. Standardized protocols and audit-feedback strategies may help reduce delays in antibiotic administration for suspected ABM.