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CSF lactate for accurate diagnosis of community-acquired bacterial meningitis

Giulieri, S. ; Chapuis-Taillard, C. ; Jaton, K. ; Cometta, A. ; Chuard, C. ; Hugli, O. ; Du Pasquier, R. ; Bille, J. ; Meylan, P. ; Manuel, O. ; Marchetti, O.

In: European Journal of Clinical Microbiology & Infectious Diseases, 2015, vol. 34, no. 10, p. 2049-2055

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    Titre
    • CSF lactate for accurate diagnosis of community-acquired bacterial meningitis
    Auteur
    • Giulieri, S.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    • Chapuis-Taillard, C.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    • Jaton, K.. Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland
    • Cometta, A.. Internal Medicine Service, Regional Hospital, Yverdon, Switzerland
    • Chuard, C.. Internal Medicine Service, Cantonal Hospital, Fribourg, Switzerland
    • Hugli, O.. Emergency Medicine Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
    • Du Pasquier, R.. Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
    • Bille, J.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    • Meylan, P.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    • Manuel, O.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    • Marchetti, O.. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Clinical Microbiology & Infectious Diseases, 2015, vol. 34, no. 10, p. 2049-2055. Springer Berlin Heidelberg
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:332674
    Summary
    CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm3), proteins (median 4115 vs. 829mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.