CSF lactate for accurate diagnosis of community-acquired bacterial meningitis.

Abstract

CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.

• Authors: S Giulieri, C Chapuis-Taillard, K Jaton, A Cometta, C Chuard, O Hugli, R Du Pasquier, J Bille, P Meylan, O Manuel, O Marchetti
• Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 34 Issue 10 Pg. 2049-55 (Oct 2015) ISSN: 1435-4373 [Electronic] Germany
• PMID: 26282789 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Receptors, Colony-Stimulating Factor
• Lactic Acid

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Cross Infection (diagnosis)
• Female
• Humans
• Lactic Acid (blood)
• Male
• Meningitis, Bacterial (blood, diagnosis)
• Meningitis, Viral (blood, diagnosis)
• Middle Aged
• Prospective Studies
• Receptors, Colony-Stimulating Factor (blood)
• Sensitivity and Specificity
• Switzerland
• Young Adult