A risk score for identifying patients at a low risk of bacterial meningitis amongst adults with cerebrospinal fluid leucocytosis and a negative gram stain result: a derivation and validation study.
| Autor: | van Soest TM; Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Horst LT; Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Chekrouni N; Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Bijlsma MW; Amsterdam UMC, Department of Pediatrics, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Brouwer MC; Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Portillo DU; Department of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA., van de Beek D; Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands., Hasbun R; Department of Internal Medicine, University of Texas Health McGovern Medical School, Houston, TX, USA. Electronic address: Rodrigo.Hasbun@uth.tmc.edu. |
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| Jazyk: | angličtina |
| Zdroj: | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2023 Mar; Vol. 29 (3), pp. 360-365. Date of Electronic Publication: 2022 Oct 08. |
| DOI: | 10.1016/j.cmi.2022.10.001 |
| Abstrakt: | Objectives: We aimed to derive and validate a risk score to differentiate patients with bacterial meningitis from those with viral meningitis or encephalitis amongst patients presenting with cerebrospinal fluid (CSF) leucocytosis and a negative Gram staining result. Methods: We included adults with bacterial and viral meningitis or encephalitis presenting with CSF leukocyte counts of >10 per mm 3 and a negative Gram staining result from cohorts in Houston, Texas (2004-2019), and the Netherlands (2012-2021). Derivation and the first validation were performed in the American patients and further validation in the Dutch patients. Results: Derivation was performed in 109 American patients with bacterial meningitis (median age, 56 years; interquartile range [IQR], 46-66 years; 46% women) and 194 with viral meningitis or encephalitis (median age, 46 years; IQR, 33-60 years; 53% women). Serum leukocyte counts of >10.0 × 10 9 /L, CSF leukocyte counts of >2000 per mm 3 , granulocyte counts of >1180 per mm 3 , protein levels of >2.2 g/L, glucose levels of <1.9 mmol/L and fever on admission were included in the risk score, which was dichotomized into 'low risk' (0 present) and 'high risk' (>0 present). The first validation showed a sensitivity of 100% (95% CI, 96.6-100) and specificity of 34.0% (95% CI, 27.4-41.2). Further validation in 262 Dutch patients with bacterial meningitis (median age, 57 years; IQR 44-70 years; 45% women) and 68 with viral meningitis (median age, 34 years; IQR, 28-45 years; 60% women) showed a sensitivity of 99.6% (95% CI, 97.9-100) and specificity of 41.2% (95% CI, 29.4-53.7). Conclusions: Our risk score may be able to rule out bacterial meningitis amongst patients presenting with CSF leucocytosis and a negative Gram staining result. However, it needs prospective testing prior to clinical implementation. (Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.) |
| Databáze: | MEDLINE |
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