Test Characteristics of Cerebrospinal Fluid Gram Stain to Identify Bacterial Meningitis in Infants Younger Than 60 Days

Balamuth, Fran; Cruz, Andrea T.; Freedman, Stephen B.; Ishimine, Paul; Garro, Aris; Curtis, Sarah; Grether-Jones, Kendra L.; Miller, Aaron S.; Uspal, Neil G.; Schmidt, Suzanne M.; Shah, Samir S.; Nigrovic, Lise E.

doi:10.1097/pec.0000000000001639

Cited by 3 publications

(2 citation statements)

References 14 publications

(30 reference statements)

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“…Second, we may have missed a child with septic arthritis because of failure to obtain a synovial fluid culture or antibiotic pretreatment rendering bacterial synovial culture falsely negative. Neither child with a positive synovial fluid Gram stain had been pretreated with antibiotics before the diagnostic procedure suggesting a false-positive Gram stain 23,24 rather than a clinical misclassification. Third, study patients did not have a synovial fluid polymerase chain reaction (PCR) testing performed.…”

Section: Discussionmentioning

confidence: 99%

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

et al. 2021

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In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells/mm 3 or greater and erythrocyte sedimentation rate of 40 mm/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort. Methods:We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population.Results: Of the 543 eligible children, 13 had septic arthritis (2.4%), 234Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%-100%; specificity, 68.1%; 95% CI, negative predictive value, 278/278 [100%]; 95% CI, 98.6%-100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis. Conclusions:The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.

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Section: Discussionmentioning

confidence: 99%

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

et al. 2021

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“…Many studies have noted that children are less likely to present with classic meningeal complaints of stiff necks, nausea, or photophobia [ 1 , 3 , 5 , 6 ]. Cerebrospinal fluid gram stain findings alone have been repeatedly found insufficient to accurately diagnose bacterial meningitis in infants [ 5 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of a Clinical Prediction Rule for Distinguishing Bacterial and Aseptic Meningitis in Pediatric Patients

Gurley,

Fukuda,

Sharma

et al. 2023

Cureus

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Introduction The treatments and prognosis of bacterial meningitis differ greatly from those of aseptic meningitis, making early identification and differentiation essential. Several different clinical prediction rules have been developed to distinguish bacterial meningitis from aseptic meningitis. We sought to validate one clinical prediction rule for pediatric patients utilizing a centralized data warehouse that collects daily data from 184 hospitals across the United States. Methods We retrospectively collected data on all patients aged 29 days to 14 years who presented to Hospital Corporation of America (HCA) Healthcare hospitals from January 1, 2016, to May 31, 2021, with a diagnosis of meningitis. Our study replicated the original study of the meningitis score for emergencies (MSE) for the pediatric clinical prediction rule and assigned 3 points for procalcitonin (PCT) >1.2 ng/dL, 2 points for CSF protein >80 mg/dL, and 1 point for each of the other variables of C-reactive protein (CRP) >40 mg/L and CSF absolute neutrophil count >1000 cells per mm 3 . Patients were categorized either as having bacterial or aseptic meningitis. Using the clinical prediction rule, a calculation of the sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve was performed. Results The optimum test characteristic was found to have a score of ≥ 3, showing a sensitivity of 92.86% (95% CI, 83.3-100), a specificity of 65.22% (95% CI, 51.5-79), a positive predictive value of 61.90% (95% CI, 47.2-76.6), and a negative predictive value of 93.75% (95% CI, 85.4-100). The ROC curve from this study showed an area under the curve (AUC) of 0.7892 (95% CI, 0.681-0.897). Conclusion Our study validated a high sensitivity for distinguishing bacterial meningitis from aseptic meningitis, suggesting the clinical prediction rule has clinical utility as a predictive screening tool. Although the original MSE advised a cutoff score of ≥1, our study suggests that a score ≥3 would give the best test performance.

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Rapid Diagnostic Tests for Meningitis and Encephalitis—BioFire

Fleischer

Aronson

2020

Pediatr Emer Care

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Meningitis and encephalitis (ME) are important causes of morbidity and mortality worldwide. Patients suspected of having ME are often hospitalized and started on empiric antimicrobial treatment, because of the potential adverse consequences of delaying the diagnosis or treatment. Multiplexed polymerase chain reaction panels are one of several rapid diagnostic technologies that have the potential to overcome some of the limitations of conventional diagnostic methods for ME. The BioFire FilmArray Meningitis/Encephalitis Panel was the first Food and Drug Administration–cleared multiplex polymerase chain reaction for the evaluation of cerebrospinal fluid samples, able to identify 14 organisms in a single test reaction. This newer rapid diagnostic tool has an overall high sensitivity and specificity for the diagnosis of ME with a fast turnaround time and has the potential to improve resource utilization for patients presenting with suspicion of ME. However, further research is needed to determine its optimal use in the evaluation of patients with suspected ME.

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Test Characteristics of Cerebrospinal Fluid Gram Stain to Identify Bacterial Meningitis in Infants Younger Than 60 Days

Cited by 3 publications

References 14 publications

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

Validation of a Clinical Prediction Rule for Distinguishing Bacterial and Aseptic Meningitis in Pediatric Patients

Rapid Diagnostic Tests for Meningitis and Encephalitis—BioFire

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