Forthcoming Issue 1 2024 Cerebrospinal Fluid Indices and Culture Concordance with Blood in Neonates with Culture-Proven Meningitis

Abstract

BACKGROUND: Diagnosing meningitis in sick-neonates is challenging because they are often unstable for lumbar puncture (LP). Antibiotic choices in this setting are based on positive blood culture (BC), assuming concordance between blood and cerebrospinal fluid (CSF) cultures. Value of CSF cultures is limited if LP is performed after starting antibiotics, hence CSF white cell count (CSF-Wcc) and chemistry are used as proxies to diagnose meningitis.

OBJECTIVES: To assess concordance between blood and CSF cultures and differences in CSF-Wcc and protein between culture-positive and -negative CSFs.

METHODS: Neonates who had both CSF and BC taken for sepsis workup were enrolled. Comparison between blood and CSF cultures was performed to assess concordance. Abnormalities in CSF-Wcc and protein levels were compared between culture-positive and -negative CSFs.

RESULTS: A total of 448 neonates had both CSF and blood taken for culture over a 12-months period. Among those with positive BC results, 16.7% had positive CSF cultures, while among those with culture-positive CSF, 59.2% had positive BC. Concordance of organisms was 82.8% among those with positive blood and CSF cultures. Only 24.5% and 59.3% of neonates with culture-positive CSF had abnormal CSF-Wcc and protein respectively. Higher proportion of neonates with culture-positive compared to culture-negative CSF had high CSF-Wcc (24.5% vs 10.4%; p<0.001), and protein (59.3% vs 37.5%; p<0.001).  

 CONCLUSION: High proportion of neonates with culture-positive CSF have negative BC, therefore, meningitis cannot be excluded on negative BC if LP has not been done. Normal CSF-Wcc and protein without CSF culture results does not exclude meningitis.