CSF markers for diagnosis of bacterial meningitis in neurosurgical postoperative patients

Abstract

-Objective: To evaluate the diagnostic usefulness of cerebral spinal fluid (CSF) cellularity, protein, neutrophils, glucose and lactate for detection of postoperative bacterial meningitis. Method: This p rospective study was conducted in 28 postoperative neuro s u rgical patients from 2002 to 2005 at University of São Paulo. The CSF markers were plotted in a receiver operating characteristic (ROC) curve to evaluate their accuracy. Results: Based on the area under ROC curve CSF glucose, cellularity, and lactate were cons i d e red good tests. Polymorphonuclear and protein did not achieve enough accuracy to be used clinicall y. Conclusion: The CSF glucose, lactate, and cellularity can be used for the diagnosis of bacterial meningitis. Moreover, it can be helpful to differentiate bacterial from aseptic meningitis.KEY WORDS: CSF, bacterial meningitis, neurosurgery, ROC analysis, postoperative infection. Baseadas na área sob a curva ROC, glicorraquia, celularidade e concentração de lactato foram considerados bons testes. A contagem de polimorf o n u c l e a res e a pro t e í n o rraquia não atingiram acurácia suficiente para serem utilizadas clinicamente. Conclusão: A glicorraquia, a concentração de lactato e a celularidade podem ser utilizadas clinicamente para o diagnóstico da meningite bacteriana. Esses marc a d o res também podem ser úteis na diferenciação entre meningite bacteriana e asséptica. PALAVRAS-CHAVE: meningite bacteriana, LCR, neurocirurgia, curva ROC, infecção pós-operatória.

Postsurgical Pantoea calida meningitis: a case report

“…Here, P. calida was isolated from the CSF of a patient with postoperative meningitis [5]. The isolate was firmly identified by using two different complementary approaches: MALDI-TOF-MS which is an advanced proteomics method [2,3] relying on the analysis of unique peptidic signatures; and partial rpoB gene sequencing which relies on the analysis of unique nucleotidic signatures [6].…”

Intracranial malignant lesions correlate with the requirement for a long treatment course in postoperative central nervous system infection

“…All the patients assessed herein received antibiotic prophylaxis prior to surgery, which likely explains the low rate of organism growth in CSF cultures (12.4%). Hence, in situations where antibiotic prophylaxis is used, other indices can help in diagnosing bacterial meningitis, including CSF glucose level, lactate content, and cell classification 17. In addition, 99% of patients with PNBM show clinical manifestations such as headache, fever, signs of meningeal irritation, and decreased consciousness 18.…”

Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

“…Our prospective findings support this, as we also found better correlation with CSF lactate than with hypoglycorrhachia. Tavares et al [23] evaluated the diagnostic usefulness of different CSF parameters for PNBM detection, and found CSF glucose and lactate are good discriminatory markers for bacterial infection (ROC 0.85 and 0.85 respectively). We found similar results for lactate (0.96, range: 0.93-1.00).…”