Audit of management of suspected bacterial meningitis in Nairobi a case study of Kenyatta National Hospital and Mbagathi County Hospital

Abstract

Background: Acute bacterial meningitis is one of the major causes of mortality causing around 135,000 deaths annually worldwide, with neurological sequel in around 21% of the survivors. In low income countries in sub Saharan Africa, the mortality rate is as high as 50%. Despite this, the countries are yet to develop standards to guide in the management of adult bacterial meningitis. The aim of this study was to determine the various practices (diagnostic and treatment practices) in the management of bacterial meningitis and evaluating them against the UK specialist guidelines 2016. Objective: The main objective of this study was to audit the practices in the management of suspected bacterial meningitis at Kenyatta National Hospital as compared to the UK specialist guidelines 2016. Study significance: This study helped highlight some of the gaps in the management of ABM and will help standardize treatment of ABM using the data already collected from this study Methodology: The study was carried out at KNH and Mbagathi District hospital. The study was carried out prospectively using an edited version 10Wi Meningococcal 2016 auditing tool on patients admitted in the medical wards with a diagnosis of bacterial meningitis. The PI noted the various diagnostic tests done on day 1 of admission; the time of antibiotic initiation and the appropriateness of the treatment by visiting the post admission ward. Further assessment of change in management based on outcomes of diagnostic tests was also done. Duration of antibiotics was assessed and the outcome of the patient documented. Data analysis was done using the SPSS Chicago Illinois version 21. Continuous variables were represented as means and standard deviations while categorical variables were presented as proportions. Duration before lumbar puncture and before initiation of treatment was analyzed using the inter-quartile ranges. Results:70 patients were recruited for the study. 6 were excluded as they were on management for cryptococcal meningitis while 1 was on management for TBM. 63 patients participated in the study, 41 from Mbagathi and 22 from KNH. 37(58.7%) of the study participants were male while 26 (41.3%) patients are female. Only 71% had LPs done with 56.2% having CT scan done after LP. Opening pressure was not recorded in 93.7% of the participants. The median duration when an LP was performed was 3 days. The right empiric treatment was given in 82.5% of the participants however none of the patients were changed to a definitive treatment once CSF results were out. The median duration of treatment was 10 days. Treatment was initiated 2 hours after admission. The mortality rate was 16%. The compliance of our study to the UK specialist guidelines was 39.03%. Conclusion: The compliance of our study to the UK specialist guidelines was 39.03%. Therefore, management of suspected bacterial meningitis is not in line with the UK specialist guidelines 2016 both in diagnostic assessment and management of these patients