CSF lactate alone is not a reliable indicator of bacterial ventriculitis in patients with ventriculostomies

Hill, Emily J.; Bleck, Thomas P.; Singh, Kamaljit; Ouyang, Bo; Busl, Katharina M.

doi:10.1016/j.clineuro.2017.03.021

Cited by 21 publications

(8 citation statements)

References 20 publications

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“…An elevated CSF lactate, procalcitonin, or their combination may be useful in diagnosing HAVM, and elevated serum procalcitonin may be useful in differentiating CSF abnormalities due to surgery or ICH from those due to bacterial infection [32••]. For CSF lactate, studies have shown cutoff values between 1.9 and 5.4 mmol/L to diagnose bacterial meningitis, but no single standard exists and not all data are conclusive, especially when a ventriculostomy is in place [35]. The cell index, assessing CSF cell counts in relation to serum counts, has been reported to have some value in diagnosing HAMV, even though the most convincing data (area under the curve of 0.825) for infection in hospitalized patients with ICH were documented in the setting of positive CSF culture [36].…”

Section: Diagnosismentioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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Purpose of Review This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. Recent Findings Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Summary Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.

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Section: Diagnosismentioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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“…Still, a cut-off for CSF-lactate of >3.5 -4.2 mmol/l has demonstrated a high reliability in predicting a non-viral meningitis as con rmed by a recent study [3]. On the other hand, CSF-lactate values alone turned out to be of relatively low predictive value with respect to the development of a postsurgical meningitis in neurosurgical patients [7,8]. This has been con rmed by a recent study of neurosurgical pediatric patients and retrospective analysis of 215 CSF-samples.…”

Section: Discussionmentioning

confidence: 91%

“…While reference values of CSF-lactate are <2 mmol/l a CSF-lactate ≥4.2 mmol/l is regarded as a strong indicator of a non-viral meningitis [2] with a diagnostic sensitivity and speci city of up to 93-99% and 88-94%, respectively [3,4]. This has been demonstrated for patients after neurosurgical interventions as well [1,5,6] even though there are contradictive results [7,8]. Within the group of neurosurgical patients those with a temporary external-drainage of the CSF are under particular risk for developing an infection of the CSF and the central nervous system.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care Detection of Lactate in Cerebrospinal Fluid

Stephani

Choi

Mörer

2021

Preprint

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Purpose: Measurements of cerebrospinal fluid (CSF)-lactate can aid in detecting infections of the central nervous system and surrounding structures. Neurosurgical patients with temporary lumbar or ventricular CSF-drainage harbor an increased risk for developing infections of the central nervous system which require immediate therapeutic responses. Since blood-gas-analyzers enable rapid blood-lactate-measurements we were interested to find out if CSF-lactate may be reliably measured by this point-of-care technique. Methods: Neurosurgical patients on our intensive care unit (ICU) with either lumbar or external ventricular drainage due to a variety of reasons were included in this prospective observational study. Standard of care included measurements of leucocyte counts, total protein and lactate measurements in CSF by the neurochemical laboratory of our University Medical Center twice a week. With respect to this study we additionally performed nearly daily measurements of cerebrospinal-fluid by blood gas analyzers to determine the reliability of CSF-lactate measured by blood-gas-analyzers as compared to the standard measurements with a certified device. Results: 62 patients were included in this study. 514 CSF measurements were performed with blood-gas-analyzers. 180 of these could be compared to the in-house standard CSF-lactate measurements. Both techniques correlated highly significant (Pearson correlation index 0.94) even though lacking full concordance in a Bland-Altman-plotting. Of particular importance, regular measurements enabled immediate detection of central infection in 3 patients who had developed meningitis during the course of their treatment.Conclusion: CSF-lactate was reliably measured by blood-gas-analyzers and detected developing meningitis timely. In addition to and triggering established CSF-diagnostics, CSF-lactate measurements by blood-gas-analyzers may improve surveillance of central nervous infections in patients with CSF-drainage. This study was retrospectively registered on April 20th 2020 in the German trial register. The trial registration number is: DRKS00021466.

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“…A meta-analysis of community-acquired meningitis patients reported high sensitivity (93%) and specificity (99%) for CSF lactate (cut-off >3.8 mmol/L) in distinguishing aseptic from bacterial meningitis [51]. However, CSF lactate is most likely to be useful in patients with very high or low values, with lesser utility in the 3-6 mmol/L range [52].…”

Section: Csf Features Of Infectionmentioning

confidence: 99%

Ventriculitis: Infection or Inflammation

2021

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Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require the insertion of an EVD, such as neurotrauma and subarachnoid hemorrhage, are themselves associated with inflammation of the cerebrospinal fluid. Phenotypically, patients with inflammation of the cerebrospinal fluid can present with very similar symptoms, signs, and laboratory findings to those with infection. This review examines various controversies relating to the definitions, diagnosis, challenges of differentiating infection from inflammation, prevention, and treatment of ventriculitis in patients with EVDs.

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CSF lactate alone is not a reliable indicator of bacterial ventriculitis in patients with ventriculostomies

Cited by 21 publications

References 20 publications

Healthcare-Associated Infections in the Neurocritical Care Unit

Healthcare-Associated Infections in the Neurocritical Care Unit

Point-of-care Detection of Lactate in Cerebrospinal Fluid

Ventriculitis: Infection or Inflammation

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