Cerebrospinal Fluid Lactate As an Indicator for Post-neurosurgical Bacterial Meningitis

Overview

Journal Indian J Crit Care Med

Specialty Critical Care

Date 2019 May 18

PMID 31097888

Citations 2

Authors

Rebai Lotfi

Boussaidi Ines

Daghmouri M Aziz

Badri Mohamed

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the interest of cerebrospinal fluid (CSF) lactate assay for the diagnosis of post-neurosurgical bacterial meningitis (PBM).

Methods: We conducted at our neurosurgical resuscitation unit a prospective study of patients who underwent elective or emergency craniotomy. Lumbar puncture was performed in all patients who had clinical suspicion of PBM for CSF culture and cytological and chemical analysis (glucose, protein, lactate). The diagnosis of PBM is made according to the criteria proposed by the Center for Disease Control and Prevention (CDC). Receiver Operating Characteristic (ROC) was used to determine the diagnostic accuracy of CSF lactate.

Results: 72 patients were studied and only 32 of them had the clinical and biological criteria of the diagnosis of PBM. Median CSF lactate was 6.18 mmol/L for PBM vs 2.63 mmol/L for no PBM (p < 0.001). CSF lactate may predict the presence PBM, with a AUC of 0.98 and NPV of 99.1. The analysis of Youden's index also confirms the good diagnostic power of CSF lactate with a value of 83 at a cut-off value of 4 mmol/L and a sensitivity of 92.3% and specificity of 91.6%.

Conclusion: Our study shows that the CSF lactate as an indicator for PBM. It is a fast and simple test that can help the clinician to optimize the management of PBM and decrease premature cessation of antibiotics.

How To Cite This Article: Lotfi R, Ines B, et al. Cerebrospinal Fluid Lactate as an Indicator for Post-neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019;23(3):127-130.

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References

Leib S, Boscacci R, Gratzl O, Zimmerli W . Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis. 1999; 29(1):69-74. DOI: 10.1086/520184. View

Druel B, Vandenesch F, Greenland T, Verneau V, Grando J, Salord F . Aseptic meningitis after neurosurgery: a demonstration of bacterial involvement. Clin Microbiol Infect. 1996; 1(4):230-234. DOI: 10.1016/s1198-743x(15)60280-4. View

Gray L, Fedorko D . Laboratory diagnosis of bacterial meningitis. Clin Microbiol Rev. 1992; 5(2):130-45. PMC: 358232. DOI: 10.1128/CMR.5.2.130. View

Wang K, Chang W, Huang C, Tsai N, Tsui H, Wang H . Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci. 2005; 12(6):647-50. DOI: 10.1016/j.jocn.2004.09.017. View

Zarrouk V, Vassor I, Bert F, Bouccara D, Kalamarides M, Bendersky N . Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis. 2007; 44(12):1555-9. DOI: 10.1086/518169. View

McClelland 3rd S, Hall W . Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007; 45(1):55-9. DOI: 10.1086/518580. View

Knudsen T, Larsen K, Kristiansen T, Moller H, Tvede M, Eugen-Olsen J . Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis: comparison with CRP and procalcitonin. Scand J Infect Dis. 2007; 39(6-7):542-53. DOI: 10.1080/00365540601113685. View

Horan T, Andrus M, Dudeck M . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32. DOI: 10.1016/j.ajic.2008.03.002. View

Beer R, Pfausler B, Schmutzhard E . Management of nosocomial external ventricular drain-related ventriculomeningitis. Neurocrit Care. 2008; 10(3):363-7. DOI: 10.1007/s12028-008-9155-y. View

10.

van de Beek D, Drake J, Tunkel A . Nosocomial bacterial meningitis. N Engl J Med. 2010; 362(2):146-54. DOI: 10.1056/NEJMra0804573. View

11.

Grille P, Torres J, Porcires F, Bagnulo H . Value of cerebrospinal fluid lactate for the diagnosis of bacterial meningitis in postoperative neurosurgical patients. Neurocirugia (Astur). 2012; 23(4):131-5. DOI: 10.1016/j.neucir.2011.11.005. View

12.

Maskin L, Capparelli F, Mora A, Hlavnicka A, Orellana N, Diaz M . Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg. 2013; 115(9):1820-5. DOI: 10.1016/j.clineuro.2013.05.034. View

13.

Tamune H, Takeya H, Suzuki W, Tagashira Y, Kuki T, Honda H . Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis. Am J Emerg Med. 2013; 32(3):263-6. DOI: 10.1016/j.ajem.2013.11.030. View

14.

Lai W, Lu C, Chang W . Mixed infection in adult post-neurosurgical bacterial meningitis: a hospital-based study. Biomed J. 2014; 36(6):295-303. DOI: 10.4103/2319-4170.113368. View

15.

Simon T, Pope C, Browd S, Ojemann J, Riva-Cambrin J, Mayer-Hamblett N . Evaluation of microbial bacterial and fungal diversity in cerebrospinal fluid shunt infection. PLoS One. 2014; 9(1):e83229. PMC: 3885436. DOI: 10.1371/journal.pone.0083229. View

16.

Li Y, Zhang G, Ma R, Du Y, Zhang L, Li F . The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis. Clin Biochem. 2014; 48(1-2):50-4. DOI: 10.1016/j.clinbiochem.2014.10.007. View

17.

Xiao X, Zhang Y, Zhang L, Kang P, Ji N . The diagnostic value of cerebrospinal fluid lactate for post-neurosurgical bacterial meningitis: a meta-analysis. BMC Infect Dis. 2016; 16:483. PMC: 5020553. DOI: 10.1186/s12879-016-1818-2. View

18.

Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A . Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect. 2017; 23(9):621-628. DOI: 10.1016/j.cmi.2017.05.013. View

19.

Blomstedt G . Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien). 1985; 78(3-4):81-90. DOI: 10.1007/BF01808684. View