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Gudina, Esayas Kebede (2016): Assessment of treatment strategies in acute bacterial meningitis in Ethiopia. Dissertation, LMU München: Medizinische Fakultät
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Abstract

Background – Management of patients with suspected bacterial meningitis needs swift clinical decision making and early antibiotic initiation. However, the care of such patients in resource limited settings is challenging due to patients’ late presentation, limited diagnostic facilities and lack of evidence based treatment guidelines. Objective – To investigate the current strategies in the management of bacterial meningitis and to assess its discharge outcomes at teaching hospitals in Ethiopia Methods – Retrospective and prospective study designs were used. In the retrospective study, data was collected at four teaching hospitals in Ethiopia from patients who were treated as a case of bacterial meningitis from December 31, 2011 to April 30, 2015. The prospective study was conducted at Jimma University Hospital from March 1, 2013 to December 31, 2015. Descriptive analyses were done for most of baseline characteristics. Bivariate and multivariable analyses were also done to identify factors associated with unfavorable outcomes. Result – (i) Retrospective study: 425 patients of age 14 years and older were included in this study. Lumbar puncture was done for only 236 (55.5%) of cases. Only 96 (22.6%) of them had cerebrospinal fluid (CSF) abnormalities compatible with bacterial meningitis. A causative bacterium was identified in only 14 of the cases. Overall, 86 patients (20.2%) died while in the hospital. (ii) Prospective study: 127 adults (≥18 years) participated in this study; 109 (85.8%) had their CSF analysed. However, only 90 (70.9%) of them had findings suggestive of bacterial meningitis and causative bacteria were isolated in only 26 (20.5%). The over all in hospital mortality was 22.8% (29 deaths). Depressed level of consciousness, focal neurologic deficits and concomitant pneumonia on presentation were associated with increased in hospital death. Adjunctive dexamethasone treatment was used in 50.4% and 33.1% in retrospective and prospective studies, respectively, and was associated with unfavorable discharge outcome. Conclusion – Outcome in patients treated for bacterial meningitis in Ethiopia was found to be poor. Moreover, most of them did not receive proper diagnostic workup and alternative diagnoses were overlooked as a result. Adjunctive dexamethasone treatment was associated with unfavorable outcome at discharge. Thus, management of patients with suspected bacterial meningitis should be supported by laboratory tests and treatment should be tailored to evidences from the settings and current evidence-based recommendations.