ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Suspected acute bacterial meningitis in adult emergency department: use of imaging before lumbar puncture and association with time to antibiotic initiation - a multicentre retrospective study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAcute 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.
methodsWe 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).
resultsIn 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).
conclusionSignificant 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.
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