Cerebrospinal fluid indices and culture concordance with blood in neonates with culture‐proven meningitis
Article Sidebar
Main Article Content
Abstract
Background. Diagnosing meningitis in sick neonates is challenging because they are often unstable for lumbar puncture (LP). In this scenario, antibiotic selections are based on positive blood culture (BC), assuming concordance between blood and cerebrospinal fluid (CSF) cultures. The value of CSF cultures is diminished when LP is performed after initiating antibiotics. Therefore, CSF white cell count (CSF-WCC) and chemistry serve as proxies for diagnosing meningitis.
Objective. To assess concordance between blood and CSF cultures and identify differences in CSF-WCC and protein levels between positive and negative CSF cultures.
Methods. We enrolled neonates who had both CSF and BCs taken for sepsis workup. Comparisons between blood and CSF cultures were performed to assess concordance. CSF-WCC and protein level discrepancies were compared between positive and negative CSF cultures.
Results. Ultimately, 448 neonates over 12 months met the criteria. Among those with positive BC results, 16.7% had positive CSF cultures, whereas for those with culture-positive CSF, 59.2% had positive BC. The concordance of organisms was 82.8% among those with positive blood and CSF cultures. Among neonates with culture-positive CSF, 24.5% and 59.3% had abnormal CSF-WCC and protein levels, respectively. Neonates with a positive CSF culture, compared with a negative culture, had higher CSF-WCC (24.5% v. 10.4%; p<0.001) and protein levels (59.3% v. 37.5%; p<0.001).
Conclusion. Most neonates with positive CSF cultures had negative BCs. Therefore, meningitis cannot be excluded based on negative BC without LP, for normal CSF-WCC and protein levels without CSF culture results do not exclude meningitis.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Hsu MH, Hsu JF, Kuo HC, et al. Neurological complications in young infants with acute bacterial meningitis. Front Neurol 2018;9:903. https://doi. org/10.3389/fneur.2018.00903
Boskabadi H, Heidari E, Zakerihamidi M. Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis. Iran J Microbiol 2020;12(2):89-97.
Garges HP, Moody MA, Cotten CM, et al. Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics 2006;117(4):1094-1100. https://doi. org/10.1542/peds.2005-1132
Okike IO, Johnson AP, Henderson KL, et al. Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and the Republic of Ireland: Prospective, enhanced, national population-based surveillance. Clin Infect Dis 2014;59(10):e150-157. https://doi.org/10.1093/ cid/ciu514
Smith PB, Garges HP, Cotton CM, et al. Meningitis in preterm neonates: Importance of cerebrospinal fluid parameters. Am J Perinatol 2008;25(7):421- 426. https://doi.org/10.1055/s-0028-1083839
Kestenbaum LA, Ebberson J, Zorc JJ, et al. Defining cerebrospinal fluid white blood cell count reference values in neonates and young infants. Pediatrics 2010;125(2):257-264. https://doi.org/10.1542/peds.2009-1181
Sarff LD, Platt LH, McCracken GH, Jr. Cerebrospinal fluid evaluation in neonates: Comparison of high-risk infants with and without meningitis. J Pediatr 1976;88(3):473-477. https://doi.org/10.1016/s0022-3476(76)80271-5
Greenberg RG, Smith PB, Cotten CM, et al. Traumatic lumbar punctures in neonates: Test performance of the cerebrospinal fluid white blood cell count. Pediatr Infect Dis J 2008;27(12):1047-1051. https://doi.org/10.1097/ INF.0b013e31817e519b
Pelkonen T, Urtti S, Dos Anjos E, et al. Aetiology of bacterial meningitis in infants aged <90 days: Prospective surveillance in Luanda, Angola. Int J Infect Dis 2020;97:251-257. https://doi.org/10.1016/j.ijid.2020.06.016
Thapa S, Sapkota LB. Changing trend of neonatal septicemia and antibiotic susceptibility pattern of isolates in Nepal. Int J Pediatr 2019;2019:3784529. https://doi.org/10.1155/2019/3784529
Xu M, Hu L, Huang H, et al. Etiology and clinical features of full-term neonatal bacterial meningitis: A multicenter retrospective cohort study. Front Pediatr 2019;7:31. https://doi.org/10.3389/fped.2019.00031
Leazer R, Erickson N, Paulson J, et al. Epidemiology of cerebrospinal fluid cultures and time to detection in term infants. Pediatrics 2017;139(5):e20163268. https://doi.org/10.1542/peds.2016-3268
Beam KS, Laughon MM, Hornik CP, et al. Predictors of positive cerebrospinal fluid cultures in infants with bacteremia. Pediatr Infect Dis J 2014;33(4):360- 365. https://doi.org/10.1097/INF.0000000000000115
Byington CL, Kendrick J, Sheng X. Normative cerebrospinal fluid profiles in febrile infants. J Pediatr 2011;158(1):130-134. https://doi.org/10.1016/j. jpeds.2010.07.022
Lyons TW, Cruz AT, Freedman SB, et al. Interpretation of cerebrospinal fluid white blood cell counts in young infants with a traumatic lumbar puncture. Ann Emerg Med 2017;69(5):622-631. https://doi.org/10.1016/j. annemergmed.2016.10.008
Aronson PL, Wang ME, Nigrovic LE, et al. Time to pathogen detection for non- ill versus ill-appearing infants =60 days old with bacteremia and meningitis. Hosp Pediatr 2018;8(7):379-384. https://doi.org/10.1542/hpeds.2018-0002
Alpern ER, Kuppermann N, Blumberg S, et al. Time to positive blood and cerebrospinal fluid cultures in febrile infants =60 days of age. Hosp Pediatr 2020;10(9):719-727. https://doi.org/10.1542/hpeds.2020-0045
Nigrovic LE, Shah SS, Neuman MI. Correction of cerebrospinal fluid protein for the presence of red blood cells in children with a traumatic lumbar puncture. J Pediatr 2011;159(1):158-159. https://doi.org/10.1016/j.jpeds.2011.02.038
Lyons TW, Cruz AT, Freedman SB, et al. Correction of cerebrospinal fluid protein in infants with traumatic lumbar punctures. Pediatr Infect Dis J 2017;36(10):1006-1008. https://doi.org/10.1097/INF.0000000000001634
Huang H, Tan J, Gong X, et al. Comparing single vs. Combined cerebrospinal fluid parameters for diagnosing full-term neonatal bacterial meningitis. Front Neurol 2019;10:12. https://doi.org/10.3389/fneur.2019.00012
deBlauwD,BruningA,VijnLJ,etal.Bloodandcerebrospinalfluidcharacteristics in neonates with a suspected central nervous system infection. Medicine 2019;98(25):e16079-e16079. https://doi.org/10.1097/MD.0000000000016079
Rajesh NT, Dutta S, Prasad R, et al. Effect of delay in analysis on neonatal cerebrospinal fluid parameters. Arch Dis Child Fetal Neonatal Ed 2010;95(1):F25- 29. https://doi.org/10.1136/adc.2008.150292
Schultz C, Temming P, Bucsky P, et al. Immature anti-inflammatory response in neonates. Clin Exp Immunol 2004;135(1):130-136. https://doi.org/10.1111/ j.1365-2249.2004.02313.x
Smith PB, Cotten CM, Garges HP, et al. A comparison of neonatal gram- negative rod and gram-positive cocci meningitis. J Perinatol 2006;26(2):111- 114. https://doi.org/10.1038/sj.jp.7211438
Cohen-Wolkowiez M, Smith PB, Mangum B, et al. Neonatal candida meningitis: Significance of cerebrospinal fluid parameters and blood cultures. J Perinatol 2007;27(2):97-100. https://doi.org/10.1038/sj.jp.7211628