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: Thijs M. van Soest, Liora ter Horst, Nora Chekrouni, Merijn W. Bijlsma, Matthijs C. Brouwer, Daniela Urueta Portillo, Diederik van de Beek, Rodrigo Hasbun
Přispěvatelé: Pediatrics, Neurology, Graduate School, Amsterdam Neuroscience - Neuroinfection & -inflammation, AII - Infectious diseases, General Paediatrics
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Clinical Microbiology and Infection
Clinical microbiology and infection. Elsevier Limited
van Soest, T M, Horst, L T, Chekrouni, N, Bijlsma, M W, Brouwer, M C, Portillo, D U, van de Beek, D & Hasbun, R 2022, ' 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 ', Clinical Microbiology and Infection . https://doi.org/10.1016/j.cmi.2022.10.001
ISSN: 1198-743X
Popis: 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 mm3 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 × 109/L, CSF leukocyte counts of >2000 per mm3, granulocyte counts of >1180 per mm3, protein levels of >2.2 g/L, glucose levels of 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.
Databáze: OpenAIRE
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