Pre-hospital Parenteral Antibiotic Treatment of Meningococcal Disease and Case Fatality: A Danish Population-based Cohort Study

B. Nørgård, H.T. Sørensen, E.S. Jensen, T. Faber, H.C. Schønheyder, G.L. Nielsen

p 144-151, Volume 45, Number 3, October 2002

Abstract

Objectives: Studies about the efficiency of pre-hospital antibiotic treatment of meningococcal disease are conflicting. We examined the case fatality rate in patients with meningococcal disease treated with pre-hospital antibiotics.

Methods: A cohort study of 534 patients hospitalized with meningococcal disease from two Danish counties. Clinical data were obtained from referral letters from general practitioners and hospital records. Complete follow-up for all patient until death or discharge.

Results: Seventy-seven patients (16% of the patients seen by a general practitioner) received parenteral antibiotics before hospital admission; 9 (12%) of them died. Of 402 patients who did not receive pre-hospital parenteral antibiotics, 26 (7%) died. The overall risk of case fatality among antibiotic-treated patients was increased with adjusted odds ratio (OR)=2.4 (95% CI, 1.0-5.6). Meningococcus serogroup B was associated with increased case fatality in patients who received pre-hospital parenteral antibiotics (OR=2.6; 95% CI, 0.8-8.3) in contrast to other serogroups. In Aarhus County there were no deaths in patients who received pre-hospital parenteral antibiotics, but in North Jutland County the case fatality was high (OR=2.9; 95% CI, 1.2-6.8).