Friday 03 May 2024
Internal Reference Number: FOI_7035
Date Request Received: 20/02/2023 00:00:00
Date Request Replied To: 04/04/2023 00:00:00
This response was sent via: By Email
Request Summary: Meningitis and Encephalitis Guidelines/Pathway
Request Category: Private Individuals
| Question Number 1: Questions for clinical team(s): Of the following, which guidelines does your Trust follow for the diagnosis and treatment of meningitis/encephalitis: (Please answer: Yes/No) • NICE Guidelines (CG102) - Bacterial meningitis in under 16s: recognition, diagnosis and management • UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults (published 2016) • Association of British Neurologists and British Infection Association National Guidelines – Management of suspected viral encephalitis in adults (published 2011) • Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines – Management of suspected viral encephalitis in children (published 2011) | |
| Answer To Question 1: Paeds - We follow the PIER network guidelines Management of Suspected Meningitis in Children - PAEDIATRIC INNOVATION, EDUCATION & RESEARCH NETWORK (piernetwork.org) these are based on NICE guidelines CG102 Adults - We do not directly audit against UK joint specialist societies or ABN guidelines, but trust wide management guidelines were structured based on the recommendations of this guidance | |
| Question Number 2: Does your Trust have any locally developed/adapted guidelines for the diagnosis and treatment of meningitis/encephalitis in both adults and paediatric patients? If yes, please state which guidelines have been adapted and please provide a copy of your local guidelines. | |
| Answer To Question 2: Paeds - These are 'locally adapted' within our region - led by tertiary infectious diseases specialist. Adults - As per paeds response and these are used trustwide in ED, critical care and medical wards | |
| Question Number 3: What are the top 3 roles in your Trust, in order of involvement, that are responsible for the development of local pathways and guidelines for meningitis/encephalitis? | |
| Answer To Question 3: We have PIER network link paediatrician and link nurse - these are probably the top 2 roles - they are Salisbury representatives on the PIER network governance group (regional) . This means that they approve guidelines on our behalf as part of the regional guideline development group. Draft guidelines are circulated widely for comment and feedback amongst the whole team. Last important role is the chair of the Childrens Governance Group (childrens matron) - who will have ultimate accountability for the guidelines that we use Guideline governance is described here Guide to development of new PIER Guidelines - PAEDIATRIC INNOVATION, EDUCATION & RESEARCH NETWORK (piernetwork.org) | |
| Question Number 4: Does your Trust typically take samples of blood cultures from patients with suspected meningitis/encephalitis within: (Please select answer) • 1 hour of admission? • 2-4 hours of admission? • 4-8 hours of admission? • 8> hours of admission? | |
| Answer To Question 4: Paeds and Adults - 1 hour - this is standard agreed practice. | |
| Question Number 5: Does your Trust consistently carry out lumbar punctures in patients with no contradictions who have suspected meningitis/encephalitis? (Yes/No) If yes, who performs the lumbar puncture? (Please specify job role) | |
| Answer To Question 5: Paeds - This is also agreed/ standard practice but we would base the decision to do this on the clinical situation, degree of concern and patient presentation and characteristics. In a baby under 6 weeks of age we would almost always do this, whereas in a much older child or adolescent then we might only do this if there was a high level of clinical concern and the lumbar puncture was definitely going to change our management The lumbar puncture is always done by a senior paediatrician (registrar or consultant) Adults - this is standard practice if there is sufficient clinical concern of bacterial meningitis or encephalitis. However it is not infrequent that after assessment by a senior clinician (consultant) that an LP is not indicated as there is a clear alternate diagnosis (for example migraine/sinusitis). | |
| Question Number 6: Does your Trust consistently take cerebrospinal fluid (CSF) samples via lumbar puncture from patients with suspected meningitis/encephalitis within: (Please select answer) • 1 hour of admission? • 1-2 hours of admission? • 2-4 hours of admission? • 4-8 hours of admission? • 8-12 hours of admission? • >12 hours of admission? | |
| Answer To Question 6: Paeds - This is age dependant and depends on the clinical situation. Our agreed standard practise is to perform an LP prior to starting antibiotics. However, we would never delay antibiotics in a child who needed them to treat meningitis in order to obtain CSF. At times we would obtain a CT scan in an older child prior to performing an LP, and for a child on antibiotics then this might be done in daylight hours (so potentially could be over 12 hours after presentation). For a baby with a patent fontanelle then we would often have performed an LP within an hour and before starting antibiotics. Adults - If there is a very high sense of suspicion of meningitis then an LP would be expedited - and in these cases this is likely 2-4 hours of admission. For patients with a much lower index of suspicion LPs are rarely performed overnight and our threshold to CT prior to LP is low (and dependant on staffing), and these cases the time could be over 12 hours. | |
| Question Number 7: Does your Trust administer antibiotics to patients where appropriate prior to taking blood culture and CSF samples? (Yes/No) | |
| Answer To Question 7: Paeds Where appropriate we would do this (give antibiotics prior to obtaining samples) - but it would be extremely unusual for us to do this in our trust without at the very least taking blood cultures. If we were unable to any blood then we would give antibiotics rather than delay them for repeated attempts. It is not unusual for patients to have been given antibiotics pre hospital by either a GP or paramedic crew if there are concerns about septicaemia. Adults - As part of the sepsis 6 protocol the aim is to obtain cultures prior to commencing antimicrobial therapy, and this is usually taken from the cannula prior to administration of IV therapy | |
| Question Number 8: Does your Trust consistently administer antibiotics to patients with suspected meningitis/encephalitis within: (Please select answer) • 1 hours of admission? • 2-4 hours of admission? • 4-8 hours of admission? • 8> hours of admission? | |
| Answer To Question 8: Paeds - 'yes' - we would always give antibiotics within an hour if we suspected meningitis or encephalitis. A. Adults - As part of the sepsis 6 protocol (and patients with meningitis are included in this), the target is to do this within 1 hour of admission. | |
| Question Number 9: Questions for lab team(s): Which of the following guidelines does your Trust follow for the microbiological investigation of meningitis/encephalitis: (Please select: Yes/No) • UK Standards for Microbiology Investigations – Meningoencepahilits (published 2014) • UK Standards for Microbiology Investigations – Investigation of Cerebrospinal Fluid (published 2017) | |
| Answer To Question 9: UK Standards for Microbiology Investigations – Meningoencephalitis (published 2014)- Yes UK Standards for Microbiology Investigations – Investigation of Cerebrospinal Fluid (published 2017)- Yes | |
| Question Number 10: Does your Trust have any local adaptations or amendments to the two UK Standards for Microbiology Investigations listed in the above question? If yes, please provide a copy of your local amendments. | |
| Answer To Question 10: Yes- UK Standards for Microbiology Investigations – Meningoencephalitis (published 2014) Cell count, gram and culture processed routinely. Virology and blood process on Microbiology consultant request | |
| Question Number 11: Following lumbar puncture on a patient with suspected meningitis/encephalitis, how long are the turnaround times from point of receiving specimen to result on the following tests: (Please select answer for each result) a) Cell count (<1 hour, 1-2 hours, 2-4 hours or >4 hours) b) Gram staining (<1 hour, 1-2 hours, 2-4 hours or >4 hours) c) Bacterial culture (<1 hour, 1-2 hours, 2-4 hours or >4 hours) d) PCR (<1 hour, 1-2 hours, 2-4 hours or >4 hours) | |
| Answer To Question 11: Cell count: 1-2 hours in lab hours, 2-4 hours out of hours Gram staining: as above Bacterial culture >4 hours PCR: 2-4 hours | |
| Question Number 12: Where does your Trust process CSF samples? | |
| Answer To Question 12: Samples processed in CL2 microbiology laboratory unless high risk clinical details | |
| Question Number 13: Does your Trust perform PCR testing to test samples from patients with suspected meningitis/encephalitis? (Yes/No) | |
| Answer To Question 13: Yes, dependant on cell count and on Consultant Microbiology request | |
| Question Number 14: If PCR testing is carried out in your Trust, which bacterial and viral pathogens are tested for? (Please separate your answer by bacterial and viral pathogens) | |
| Answer To Question 14: BACTERIA: Escherichia coli K1 Haemophilus influenzae Listeria monocytogenes Neisseria meningitidis Streptococcus agalactiae Streptococcus pneumoniae VIRUSES: Cytomegalovirus (CMV) Enterovirus (EV) Herpes simplex virus 1 (HSV-1) Herpes simplex virus 2 (HSV-2) Human herpesvirus 6 (HHV-6) Human parechovirus (HPeV) Varicella zoster virus (VZV) YEAST: Cryptococcus (C. neoformans/C. gattii) | |
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