Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age

Abstract

Background There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis. Objective To evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort. Methods This cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians. Results Forty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 10 6 /L, providing a sensitivity of 91% and specificity of 88%. Conclusion In this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.

Clinical Features and a Prediction Nomogram for Prognosis in Children with Escherichia coli Meningitis

“…2 Repeat lumbar puncture (LP) is recommended during the treatment of children with bacterial meningitis. 36,37 In children with bacterial meningitis, changes in cerebrospinal fluid cannot directly indicate the persistence of bacteria or predict the recurrence or reignition of intracranial infection. In this study, there were significant differences in the last cerebrospinal fluid glucose content before discharge between the good prognosis and poor prognosis groups.…”

Practice Summary of Antimicrobial Therapy for Commonly Encountered Conditions in the Neonatal Intensive Care Unit: A Canadian Perspective

“…Conducting LP is important in the diagnosis of meningitis, although its interpretation can be affected by the high frequency of traumatic LPs and the variability of cytologic and biochemical indices in the neonatal population (121). Repeated CSF fluid parameters may provide additional insights into the treatment response and adverse effects from the outcomes of bacterial meningitis (122). Bacterial nucleic acid detection in CSF (such as 16s ribosomal RNA) can be useful if CSF culture results are negative because of preceding antibiotic therapy.…”

The clinical condition rather than cerebrospinal fluid levels may guide the optimal duration of antimicrobial therapy among neonates with bacterial meningitis: A single‐center retrospective study

“…6 However, there are controversies in the guidelines in the warrants regarding the indications for repeat lumbar puncture or in the explanation of the results. 7,8 In addition, prolongation of antibiotic treatment may increase the resistance of pathogenic bacteria and lead to potential diseases such as necrotizing enterocolitis, and candidiasis in neonates. 9,10 Hence, it is very important to explore the predictive value of end-of-therapy CSF levels in neonates.…”

“…Continuous monitoring of CSF levels during antimicrobial treatment of bacterial meningitis in young infants is recommended by some specialists, which may prolong the use of antibiotics 6 . However, there are controversies in the guidelines in the warrants regarding the indications for repeat lumbar puncture or in the explanation of the results 7,8 . In addition, prolongation of antibiotic treatment may increase the resistance of pathogenic bacteria and lead to potential diseases such as necrotizing enterocolitis, and candidiasis in neonates 9,10 .…”