Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa

Emma C. Wall; Mavuto Mukaka; Brigitte Denis; Veronica S. Mlozowa; Malango Msukwa; Khumbo Kasambala; Mulinda Nyrienda; Theresa J. Allain; Brian Faragher; Robert S. Heyderman; David Lalloo

doi:10.1371/journal.pone.0186687

Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa

Emma C. Wall, Mavuto Mukaka, Brigitte Denis, Veronica S. Mlozowa, Malango Msukwa, Khumbo Kasambala, Mulinda Nyrienda, Theresa J. Allain, Brian Faragher, Robert S. Heyderman, David Lalloo

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Background

Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi.

Materials and methods

Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1). In year two (P2), nurses delivered protocolised GDT (rapid antibiotics, airway support, oxygenation, seizure control and fluid resuscitation) to a second cohort. The primary endpoint was composite mean number of clinical goals attained. Secondary endpoints were individual goals attained and death or disability from proven or probable ABM at day 40.

Results

563 patients with suspected ABM were enrolled in the study; 273 were monitored in P1; 290 patients with suspected ABM received GDT in P2. 61% were male, median age 33 years and 90% were HIV co-infected. ABM was proven or probable in 132 (23%) patients. GDT attained more clinical goals compared to routine care: composite mean number of goals in P1 was 0·55 vs. 1·57 in P2 GDT (p<0·001); Death or disability by day 40 from proven or probable ABM occurred in 29/57 (51%) in P1 and 38/60 (63%) in P2 (p = 0·19).

Conclusion

Nurse-led GDT in a resource-constrained setting was associated with improved delivery of protocolised care. Outcome was unaffected. Trial registration www.isrctn.com ISRCTN96218197

Original language	English
Article number	e0186687
Pages (from-to)	e0186687
Journal	PLoS ONE
Volume	12
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0186687
Publication status	Published - 27 Oct 2017

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PLoS Goal directed therapy for suspected acuteFinal published version, 2.54 MBLicence: CC BY

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title = "Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa",

abstract = "Background Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50\%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi. Materials and methods Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1). In year two (P2), nurses delivered protocolised GDT (rapid antibiotics, airway support, oxygenation, seizure control and fluid resuscitation) to a second cohort. The primary endpoint was composite mean number of clinical goals attained. Secondary endpoints were individual goals attained and death or disability from proven or probable ABM at day 40. Results 563 patients with suspected ABM were enrolled in the study; 273 were monitored in P1; 290 patients with suspected ABM received GDT in P2. 61\% were male, median age 33 years and 90\% were HIV co-infected. ABM was proven or probable in 132 (23\%) patients. GDT attained more clinical goals compared to routine care: composite mean number of goals in P1 was 0·55 vs. 1·57 in P2 GDT (p<0·001); Death or disability by day 40 from proven or probable ABM occurred in 29/57 (51\%) in P1 and 38/60 (63\%) in P2 (p = 0·19). Conclusion Nurse-led GDT in a resource-constrained setting was associated with improved delivery of protocolised care. Outcome was unaffected. Trial registration www.isrctn.com ISRCTN96218197",

author = "Wall, \{Emma C.\} and Mavuto Mukaka and Brigitte Denis and Mlozowa, \{Veronica S.\} and Malango Msukwa and Khumbo Kasambala and Mulinda Nyrienda and Allain, \{Theresa J.\} and Brian Faragher and Heyderman, \{Robert S.\} and David Lalloo",

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doi = "10.1371/journal.pone.0186687",

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T1 - Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa

AU - Wall, Emma C.

AU - Mukaka, Mavuto

AU - Denis, Brigitte

AU - Mlozowa, Veronica S.

AU - Msukwa, Malango

AU - Kasambala, Khumbo

AU - Nyrienda, Mulinda

AU - Allain, Theresa J.

AU - Faragher, Brian

AU - Heyderman, Robert S.

AU - Lalloo, David

PY - 2017/10/27

Y1 - 2017/10/27

N2 - Background Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi. Materials and methods Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1). In year two (P2), nurses delivered protocolised GDT (rapid antibiotics, airway support, oxygenation, seizure control and fluid resuscitation) to a second cohort. The primary endpoint was composite mean number of clinical goals attained. Secondary endpoints were individual goals attained and death or disability from proven or probable ABM at day 40. Results 563 patients with suspected ABM were enrolled in the study; 273 were monitored in P1; 290 patients with suspected ABM received GDT in P2. 61% were male, median age 33 years and 90% were HIV co-infected. ABM was proven or probable in 132 (23%) patients. GDT attained more clinical goals compared to routine care: composite mean number of goals in P1 was 0·55 vs. 1·57 in P2 GDT (p<0·001); Death or disability by day 40 from proven or probable ABM occurred in 29/57 (51%) in P1 and 38/60 (63%) in P2 (p = 0·19). Conclusion Nurse-led GDT in a resource-constrained setting was associated with improved delivery of protocolised care. Outcome was unaffected. Trial registration www.isrctn.com ISRCTN96218197

AB - Background Mortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi. Materials and methods Sequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1). In year two (P2), nurses delivered protocolised GDT (rapid antibiotics, airway support, oxygenation, seizure control and fluid resuscitation) to a second cohort. The primary endpoint was composite mean number of clinical goals attained. Secondary endpoints were individual goals attained and death or disability from proven or probable ABM at day 40. Results 563 patients with suspected ABM were enrolled in the study; 273 were monitored in P1; 290 patients with suspected ABM received GDT in P2. 61% were male, median age 33 years and 90% were HIV co-infected. ABM was proven or probable in 132 (23%) patients. GDT attained more clinical goals compared to routine care: composite mean number of goals in P1 was 0·55 vs. 1·57 in P2 GDT (p<0·001); Death or disability by day 40 from proven or probable ABM occurred in 29/57 (51%) in P1 and 38/60 (63%) in P2 (p = 0·19). Conclusion Nurse-led GDT in a resource-constrained setting was associated with improved delivery of protocolised care. Outcome was unaffected. Trial registration www.isrctn.com ISRCTN96218197

U2 - 10.1371/journal.pone.0186687

DO - 10.1371/journal.pone.0186687

M3 - Article

VL - 12

SP - e0186687

JO - PLoS ONE

JF - PLoS ONE

IS - 10

M1 - e0186687

ER -

Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa

Abstract

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