Predictive Value of Cerebrospinal Fluid (CSF) Lactate Level Versus CSF/Blood Glucose Ratio for the Diagnosis of Bacterial Meningitis Following Neurosurgery

Leib, Stephen L.; Boscacci, Rémy; Gratzl, O.; Zimmerli, Werner

doi:10.1086/520184

Cited by 150 publications

(98 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There is substantial evidence that whenever cerebral glycolysis is increased due to causes such as anaerobic glycolysis, hypoxia, ischemia, seizures or meningitis (42), lactate and pyruvate concentrations in brain and CSF and the lactate-to-pyruvate ratio are increased. However, measurement of CSF lactate concentrations was found to be superior to the ratio of CSF to blood glucose for the diagnosis of bacterial meningitis in postoperative neurological patients (9,43). In partially treated bacterial meningitis, CSF lactate at a decision limit of )3.2 mmol/L classified 88% of treated bacterial meningitis patients with 83% sensitivity and 91% specificity (12) at a decision limit of )3.5 mmol/L, CSF lactate sensitivity decreased to 72% (36).…”

Section: Figure 1 Csf Lactic Acid (Mmol/l) Concentration In the Studimentioning

confidence: 99%

See 1 more Smart Citation

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Almeida

Faria

Fontes

et al. 2009

Clinical Chemistry and Laboratory Medicine

View full text Add to dashboard Cite

Background: The differential diagnosis between bacterial and viral meningitis is not easy in some cases. Cerebrospinal fluid (CSF) analysis is essential for establishing this diagnosis. The objectives were to quantitate lactic acid (LA) concentrations in bacterial and viral meningitis, and other central nervous system (CNS) diseases in order to evaluate the diagnostic utility of CSF LA for discriminating bacterial from viral meningitis. Methods: CSF LA was measured in 139 CSF samples from seven groups: viral meningitis with classic CSF; suspicion of viral meningitis with neutrophils in CSF; bacterial meningitis; non-infectious neurological diseases; chronic meningitis; traumatic lumbar puncture (LP) and normal CSF. Results: CSF LA was higher in bacterial meningitis 8.7q5.4 mmol/L compared with viral meningitis (1.9q0.6) and the other groups (p-0.0001). CSF LA in the groups with viral meningitis was not different compared to groups with non-infectious CNS diseases and chronic meningitis. The ability of CSF LA to discriminate bacterial from viral meningitis showed a sensitivity of 80% and specificity of 97%, positive predictive value (PPV) of 94%, and negative predictive value (NPV) of 89%. Conclusions: CSF LA is a powerful test to discriminate bacterial from viral meningitis with high sensitivity,

show abstract

Section: Figure 1 Csf Lactic Acid (Mmol/l) Concentration In the Studimentioning

confidence: 99%

“…CSF lactic acid (LA) is considered a good biomarker for differentiating bacterial from viral meningitis at a cut-off of 3.5 mmol/L (8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Almeida

Faria

Fontes

et al. 2009

Clinical Chemistry and Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…is their increasing resistance to almost all antibiotic classes (including carbapenems), which has been a significant problem in the recent years. 1,4,10,16,22,25,30,36 Klebsiella spp. were the second most commonly isolated pathogens in this cohort, with the isolates carrying a high degree of resistance to third-generation cephalosporins and carbapenems (Table 4).…”

Section: Meningitismentioning

confidence: 99%

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

Kourbeti¹,

Vakis²,

Ziakas

et al. 2015

JNS

136

View full text Add to dashboard Cite

OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilatorassociated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics.

show abstract

“…Other studies have found values ranging from 3.5 to 4.2 mmol/L as the best sensitivity and specificity for meningitis. 6,[10][11][12] There was a slight discrepancy between POCL and SLL values in our study; this result is not likely to be clinically meaningful, because the mean difference was only approximately 0.5 mmol/L.…”

Section: Discussionmentioning

confidence: 75%

“…However, CSF lactate concentration can help discriminate between bacterial and non-bacterial meningitis. [5][6][7] Such testing is limited by the requirements of specialized equipment and the maintenance of a cold chain. Reducing laboratory requirements and improving the time to CSF lactate results may improve the ability to diagnose and treat bacterial meningitis.…”

Section: Introductionmentioning

confidence: 99%

Handheld Point-of-Care Cerebrospinal Fluid Lactate Testing Predicts Bacterial Meningitis in Uganda

Majwala

Burke²,

Patterson³

et al. 2013

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. We validated a handheld point-of-care lactate (POCL) monitor's ability to measure lactate in cerebrospinal fluid (CSF) and diagnose bacterial meningitis in Uganda. There was a strong linear correspondence between POCL and standard laboratory lactate test results (R 2 = 0.86; P 0.001). For 145 patients with clinical meningitis, the area under the receiver operating characteristic curve for the prediction of bacterial meningitis by CSF POCL was 0.92 (95% confidence interval = 0.85-0.99, P 0.001). A CSF POCL concentration of 7.7 mmol/L provided 88% sensitivity and 90% specificity for the diagnosis of bacterial meningitis. CSF POCL testing had excellent use in the diagnosis of bacterial meningitis, and it may be useful where CSF analyses are delayed or laboratory infrastructure is limited.

show abstract

Predictive Value of Cerebrospinal Fluid (CSF) Lactate Level Versus CSF/Blood Glucose Ratio for the Diagnosis of Bacterial Meningitis Following Neurosurgery

Cited by 150 publications

References 31 publications

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Quantitation of cerebrospinal fluid lactic acid in infectious and non-infectious neurological diseases

Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis

Handheld Point-of-Care Cerebrospinal Fluid Lactate Testing Predicts Bacterial Meningitis in Uganda

Contact Info

Product

Resources

About