Management of suspected paediatric meningitis: a multicentre prospective cohort study

Ramasamy, Roshan; Willis, Louise; Kadambari, Seilesh; Kelly, Dominic F.; Heath, Paul T; Nadel, Simon; Pollard, Andrew J.; Sadarangani, Manish

doi:10.1136/archdischild-2017-313913

Cited by 12 publications

(16 citation statements)

References 33 publications

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“…For these reasons, in many babies bacterial meningitis cannot be promptly confirmed or ruled out with confidence. Consequently, there is a risk of over-treatment with unnecessary hospitalisation and antibiotic exposurea frequent problem encountered in the management of paediatric meningitis [17]. The sensitivity of the detection can be increased many-fold by PCR, which has already been widely used for diagnosis of infections (including meningitis) [38].…”

Section: Discussionmentioning

confidence: 99%

“…The overwhelming majority of these babies do not have bacterial meningitis [6,15,16]. However, poor sensitivity of CSF bacterial culture and uncertainties in the interpretation of CSF microcopy can result in unnecessary hospitalization and treatment, with associated costs and risks [17]. We therefore speculated that an assay sensitive enough to accurately discriminate bacteria-free CSF would facilitate accurate exclusion of bacterial meningitis, with early discontinuation of antibiotic treatment and discharge from hospital.…”

Section: Introductionmentioning

confidence: 99%

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Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay

et al. 2020

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Background: PCRctic is an innovative assay based on 16S rDNA PCR technology that has been designed to detect a single intact bacterium in a specimen of cerebro-spinal fluid (CSF). The assay's potential for accurate, fast and inexpensive discrimination of bacteria-free CSF makes it an ideal adjunct for confident exclusion of bacterial meningitis in newborn babies where the negative predictive value of bacterial culture is poor. This study aimed to stress-test and optimize PCRctic in the "field conditions" to attain a clinically useful level of specificity. Methods: The specificity of PCRctic was evaluated in CSF obtained from newborn babies investigated for meningitis on a tertiary neonatal unit. Following an interim analysis, the method of skin antisepsis was changed to increase bactericidal effect, and snap-top tubes (Eppendorf™) replaced standard universal containers for collection of CSF to reduce environmental contamination. Results: The assay's specificity was 90.5% in CSF collected into the snap-top tubesup from 60% in CSF in the universal containers. The method of skin antisepsis had no effect on the specificity. All CSF cultures were negative and no clinical cases of neonatal bacterial meningitis occurred during the study. Conclusions: A simple and inexpensive optimization of CSF collection resulted in a high specificity output. The low prevalence of neonatal bacterial meningitis means that a large multi-centre study will be required to validate the assay's sensitivity and its negative predictive value.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay

et al. 2020

View full text Add to dashboard Cite

show abstract

“…For these reasons, in many babies bacterial meningitis cannot be promptly con rmed or ruled out with con dence. Consequently, there is a risk of over-treatment with unnecessary hospitalisation and antibiotic exposure -a frequent problem encountered in the management of paediatric meningitis [17].…”

Section: Discussionmentioning

confidence: 99%

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay.

Abelian

Mund

Curran

et al. 2020

Preprint

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Background: PCRctic is an innovative assay based on 16S rDNA PCR technology that has been designed to detect a single intact bacterium in a specimen of cerebro-spinal fluid (CSF). The assay’s potential for accurate, fast and inexpensive discrimination of bacteria-free CSF makes it an ideal adjunct for confident exclusion of bacterial meningitis in newborn babies where the negative predictive value of bacterial culture is poor. This study aimed to stress-test and optimize PCRctic in the “field conditions” to attain a clinically useful level of specificity.Methods: The specificity of PCRctic was evaluated in CSF obtained from newborn babies investigated for meningitis on a tertiary neonatal unit. Following an interim analysis, the method of skin antisepsis was changed to increase bactericidal effect, and snap-top tubes (EppendorfTM) replaced standard universal containers for collection of CSF to reduce environmental contamination.Results: The assay’s specificity was 90.5% in CSF collected into the snap-top tubes – up from 60% in CSF in the universal containers. The method of skin antisepsis had no effect on the specificity. All CSF cultures were negative and no clinical cases of neonatal bacterial meningitis occurred during the study. Conclusions: a simple and inexpensive optimization of CSF collection resulted in a high specificity output. The low prevalence of neonatal bacterial meningitis means that a large multi-centre study will be required to validate the assay’s sensitivity and its negative predictive value.

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“…Consequently, there is a risk of over-treatment with unnecessary hospitalisation and antibiotic exposure -a frequent problem encountered in the management of paediatric meningitis [17].…”

Section: Discussionmentioning

confidence: 99%

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay.

Abelian

Mund

Curran

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: PCRctic is an innovative assay based on 16S rDNA PCR technology that has been designed to detect a single intact bacterium in a specimen of cerebro-spinal fluid (CSF). The assay’s potential for accurate, fast and inexpensive discrimination of bacteria-free CSF makes it an ideal adjunct for confident exclusion of bacterial meningitis in newborn babies where the negative predictive value of bacterial culture is poor. This study aimed to stress-test and optimize PCRctic in the “field conditions” to attain a clinically useful level of specificity. Methods: The specificity of PCRctic was evaluated in CSF obtained from newborn babies investigated for meningitis on a tertiary neonatal unit. Following an interim analysis, the method of skin antisepsis was changed to increase bactericidal effect, and snap-top tubes (EppendorfTM) replaced standard universal containers for collection of CSF to reduce environmental contamination. Results: The assay’s specificity was 90.5% in CSF collected into the snap-top tubes – up from 60% in CSF in the universal containers. The method of skin antisepsis had no effect on the specificity. All CSF cultures were negative and no clinical cases of neonatal bacterial meningitis occurred during the study.Conclusions: a simple and inexpensive optimization of CSF collection resulted in a high specificity output. The low prevalence of neonatal bacterial meningitis means that a large multi-centre study will be required to validate the assay’s sensitivity and its negative predictive value.

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Management of suspected paediatric meningitis: a multicentre prospective cohort study

Abstract: Most children had LP after antibiotics were administered, reducing yield from CSF culture, and PCRs were underused despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment.

Cited by 12 publications

References 33 publications

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay.

Towards accurate exclusion of neonatal bacterial meningitis: a feasibility study of a novel 16S rDNA PCR assay.

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