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Meningitis and Encephalitis Guidelines/Pathway

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Niklas Marksteiner

Dear FOI contact,

I am writing to request your assistance with an open government request according to the Freedom of Information Act 2000.

Please kindly complete the below questions.

Questions for clinical team(s):

1. 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)

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.

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?

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?

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)

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?

7. Does your Trust administer antibiotics to patients where appropriate prior to taking blood culture and CSF samples? (Yes/No)

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?

Questions for lab team(s):

9. 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)

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.

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)

12. Where does your Trust process CSF samples?

13. Does your Trust perform PCR testing to test samples from patients with suspected meningitis/encephalitis? (Yes/No)

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)

Thank you for taking the time to supply this information.

Yours faithfully,
Kimrin Pannu

oxford@infreemation.co.uk, Oxford University Hospitals NHS Foundation Trust

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John Radcliffe Hospital
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Oxford
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For information about how the Trust processes personal data, or if you
want to make a request for personal data (including medical records),
please refer to our privacy notice - [4]http://www.ouh.nhs.uk/privacy/.

Kind regards

Freedom of Information Team
Oxford University Hospitals NHS Foundation Trust
John Radcliffe Hospital
Headley Way
Headington
Oxford
OX3 9DU

References

Visible links
1. https://oxford.disclosure-log.co.uk/
2. https://ico.org.uk/make-a-complaint/offi...
3. https://www.ouh.nhs.uk/about/foi/what-we...
4. http://www.ouh.nhs.uk/privacy/

oxford@infreemation.co.uk, Oxford University Hospitals NHS Foundation Trust

4 Attachments

Dear Niklas Marksteiner

The Oxford University Hospitals NHS Foundation Trust is writing to respond
to your request, F23-8680, sent 20/02/2023.

Please see below your request and the Trust’s response below.

 

1. 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 

Yes (Children’s)

• UK Joint Specialist Societies guideline on the diagnosis and management
of acute meningitis and meningococcal sepsis in immunocompetent adults
(published 2016) 

Yes (Adults)

• Association of British Neurologists and British Infection Association
National Guidelines – Management of suspected viral encephalitis in adults
(published 2011) 

Yes (Adults)

• Association of British Neurologists and British Paediatric Allergy,
Immunology and Infection Group National Guidelines – Management of
suspected viral encephalitis in children (published 2011) 

Yes Children

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.

UK Joint Specialist Societies - Attached

Our local Microguide - Attached

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? 

• OXMID Lead (Oxford Microbiology and Infectious Diseases - governance
group) 
• Antimicrobial Stewardship Group Lead. Determines our guidelines and
ensures they are kept up to date. This includes lead Infection Doctors
for Adults and Paediatrics, and a lead Pharmacist 
• Medicines Management and Therapeutics Committee Lead 

Our procedure for guideline development goes through OXMID and ASG with
final approval from MMTC. 

4. Does your Trust typically take samples of blood cultures from patients
with suspected meningitis/encephalitis within: (Please select answer)
• 1 hour of admission? Yes
• 2-4 hours of admission?
• 4-8 hours of admission?
• 8> hours of admission?

5. Does your Trust consistently carry out lumbar punctures in patients
with no contradictions who have suspected meningitis/encephalitis?
(Yes/No) Yes

If yes, who performs the lumbar puncture? (Please specify job role) The
most appropriate doctor in the medical/paediatric team – this is most
commonly the medical registrar.

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?

We have not audited this recently. We would expect the median time to
taking CSF samples to be 4-8 hours from admission. 

 

7. Does your Trust administer antibiotics to patients where appropriate
prior to taking blood culture and CSF samples? (Yes/No) 

Yes – our guidance emphasises the need for prompt antimicrobials when
meningitis/encephalitis expected and would wish to avoid delays in
antimicrobials while cultures obtained. We endeavour to take early
cultures too.

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?

We do not have audit data for those presenting with meningitis /
encephalitis though would aim for this to be within 1 hour of
presentation.  

Several of these patients would meet the criteria for ‘suspected sepsis’ -
evidence of infection (fever, elevated CRP, “infection concern”) AND high
risk criteria (altered mental state, hypotension, tachycardia etc.).
Antibiotics were given within 60 minutes for 86% of suspected sepsis cases
in 2022, though this would include many patients with an alternative
diagnosis.  

 

9. 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) 

YES

• UK Standards for Microbiology Investigations – Investigation of
Cerebrospinal Fluid (published 2017) 

YES

10. Does your Trust have any local adaptations or amendments to the two UK
Standards for Microbiology Investigations listed in the above question? 

NO

If yes, please provide a copy of your local amendments.

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) 72% reported in
<4hours (as per SMI)

b) Gram staining (<1 hour, 1-2 hours, 2-4 hours or >4 hours) 72% reported
in <4hours (as per SMI)

c) Bacterial culture (<1 hour, 1-2 hours, 2-4 hours or >4
hours) Inappropriate question, as all bacterial cultures take >16 hours

d) PCR (<1 hour, 1-2 hours, 2-4 hours or >4 hours) 91% reported in <24
hours

12. Where does your Trust process CSF samples? Within the Microbiology
department, for those requiring microbiological analysis

13. Does your Trust perform PCR testing to test samples from patients with
suspected meningitis/encephalitis? (Yes/No) 

Yes, on those that meet testing criteria

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) 

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) 

We don't know whether the most recent response to this request contains information or not – if you are Niklas Marksteiner please sign in and let everyone know.