The attitudes, behaviors, and knowledge of healthcare professionals towards the diagnosis, treatment, and prevention of bacterial meningitis in Turkey

Introduction: Bacterial meningitis is one of the leading causes of morbidity and mortality among children and adults. Better understanding of the seroepidemiology of meningitis is critical for both the selection and implementation of an effective meningitis vaccine for the national immunization program. Because physicians play a crucial role in the implementation of this vaccine, the aim of this study was to evaluate the attitudes, behaviors, and knowledge of healthcare professionals in Turkey regarding the diagnosis, treatment and prevention of bacterial meningitis, especially pneumococcal and meningococcal meningitis. Methods: This study used a cross-sectional electronic survey with a national convenience sample of 339 physicians (171 pediatric age specialists [PAS] and 168 adult patient specialists [APS]) in Turkey. A web-based questionnaire which consisted 28 questions about the definition, diagnosis, and treatment of bacterial as well as knowledge and/or attitudes about meningococcal vaccines, was designed. Results: Approximately 72.9% (n = 247) of the respondents followed a patient with meningitis in the last year. A 49.5% of participants preferred to perform computerized cranial tomography (CCT) for suspected meningitis cases before lumbar puncture (LP) at 75-100% frequency (27.5% PAS; 72% APS, p ). In addition 27.1% of the respondents reported using a routine steroid as an adjunctive treatment (19% PAS; 35% APS, p ). For meningococcal meningitis, 72.5% of the participants preferred to use third-generation cephalosporins (63.1% PAS; 82.1% APS, p ). For pneumococcal meningitis, approximately 50% of the participants preferred to use a third-generation cephalosporin plus glycopeptide (41.5% PAS; 58.9% APS, p < .05). While 32.7% of the sample preferred to administer a 7-day course of antibiotics for meningococcal meningitis, 40.9% preferred a course of 14 days or more. For pneumococcal meningitis, 88.4% of the sample preferred a 10-14 day course of antibiotics. In addition, 67% of the PAS group and 50% (p < .001) of the APS group thought that a conjugated meningococcal vaccine should be a part of the National Immunization Program. The top five groups recommended for routine immunization included all children, asplenia/splenectomy patients, immunodeficient patients, those who planned to travel to endemic areas, including Hajj, and military personnel. Conclusion: In this large convenient sample of physicians in Turkey, we showed that there are heterogenous approaches to the diagnosis and treatment of bacterial meningitis, also differences between pediatricians and non-pediatricians regarding their beliefs and attitudes, which may be due to differences in the epidemiology and clinical presentation between children and adults. We observed appropriate but unnecessary extended courses of antibiotics for meningitis. Most of the participants thought that children are a vulnerable risk group that should potentially be immunized and that meningococcal vaccines should be included in the National Immunization Program. Our results imply that more awareness is needed regarding diagnosis, treatment, and further recommendations for meningitis at the country level in Turkey.