Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

Maskin, Luis Patricio; Capparelli, Federico J; Mora, Andrea; Hlavnicka, Alejandro; Orellana, Nora; Díaz, Maria Fernanda; Wainsztein, Néstor; Castillo, Marcelo Del

doi:10.1016/j.clineuro.2013.05.034

Cited by 43 publications

(42 citation statements)

References 38 publications

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“…In people, brain hypoxia and vascular compromise (ie, intracranial hemorrhage, mass lesions, trauma, stroke, seizures, hypoglycemic coma) also increase CSF [LAC] . When confounding conditions have been excluded, CSF [LAC] can differentiate septic from aseptic meningitis . In a meta‐analysis including 33 studies and 1,885 people, the measurement of CSF [LAC] had a pooled sensitivity of 93% (95% CI 0.89–0.96) and specificity of 96% (95% CI 0.93–0.98) in discriminating septic from aseptic meningitis using a cut‐off of 3.9 mmol/L .…”

Section: Measurement Of Lactate In Other Body Fluidsmentioning

confidence: 99%

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

Rosenstein

Tennent‐Brown

Hughes

2018

J Vet Emergen Crit Care

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Section: Measurement Of Lactate In Other Body Fluidsmentioning

confidence: 99%

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

Rosenstein

Tennent‐Brown

Hughes

2018

J Vet Emergen Crit Care

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“…This has led to debate on how VRIs should be diagnosed and monitored and when empirical treatment should be considered. Several strategies have been proposed such as routine CSF cultures in all patients with ventriculostomy catheters, calculation of indices relating cell count in CSF to blood [30], and the analysis of CSF lactate as a reliable indicator of VRI [19, 25]. Hitherto, no consensus has been reached.…”

Section: Introductionmentioning

confidence: 99%

Ventriculostomy-related infections in subarachnoid hemorrhage patients—a retrospective study of incidence, etiology, and antimicrobial therapy

et al. 2016

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BackgroundThis study was performed to investigate the incidence and etiology of ventriculostomy-related infections (VRIs) in patients with subarachnoid hemorrhage (SAH) and to assess adherence to local clinical guidelines regarding empirical antimicrobial therapy and diagnostic routines.MethodsA total of 191 consecutive SAH patients treated in the neuro-intensive care unit of Uppsala University Hospital between 2010 and 2013 were included retrospectively. Information regarding cerebrospinal fluid samples, bacterial cultures, ventriculostomy treatment, patient characteristics, and antibiotic treatment were collected from electronic patient records.ResultsEleven patients developed VRI, resulting in an incidence of 5.8% per patient, 5.4% per ventriculostomy catheter, and 4.1 per 1000 catheter days. Coagulase-negative staphylococci caused nine cases of VRI and Klebsiella pneumoniae and Staphylococcus aureus caused one each. Empirical VRI therapy was initiated on 97 occasions in 81 subjects (42.4%). Out of the 11 patients with VRI, four did not receive empirical antibiotic therapy before the positive culture result. The clinical actions performed after analysis of CSF samples were in line with the action suggested by the local guidelines in 307 out of 592 cases (51.9%).ConclusionsThe incidence of VRI in our cohort was comparable to what has previously been reported. Coagulase-negative staphylococci was the most common agent. Our study demonstrates the difficulty in diagnosing VRI in SAH patients. Improved adherence to clinical guidelines could to some extent reduce the use of empirical antibiotic treatment, but better diagnostic methods and routines are needed.

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“…Because subarachnoid hemorrhage and brain injury are known to cause hyperglycolysis, it is not surprising that CSF lactate may be elevated in these patients. Metabolic suppressive therapies (benzodiazepines and opiates) have also been shown to decrease CSF lactate concentrations in this population, and specific elevations in CSF lactate concentrations (mean 3.2 ± 0.9 mmol/L) have been associated with withdrawal of sedation [80,81]. In a prospective clinical study to evaluate the diagnostic accuracy of CSF lactate as a marker of post-neurosurgical bacterial meningitis [80], increased CSF lactate (≥4 mmol/L) demonstrated a better predictive value than CSF hypoglycorrhachia or pleocytosis and had a sensitivity of 97% and specificity of 78%, with a 97% negative predictive value.…”

Section: Evidence Summary Lactatementioning

confidence: 99%

“…Metabolic suppressive therapies (benzodiazepines and opiates) have also been shown to decrease CSF lactate concentrations in this population, and specific elevations in CSF lactate concentrations (mean 3.2 ± 0.9 mmol/L) have been associated with withdrawal of sedation [80,81]. In a prospective clinical study to evaluate the diagnostic accuracy of CSF lactate as a marker of post-neurosurgical bacterial meningitis [80], increased CSF lactate (≥4 mmol/L) demonstrated a better predictive value than CSF hypoglycorrhachia or pleocytosis and had a sensitivity of 97% and specificity of 78%, with a 97% negative predictive value. However, a retrospective review of cases of bacterial meningitis associated with a CSF shunt showed that if a cutoff value of 4 mmol/L for CSF lactate had been used, almost half of the infections would have been missed [14].…”

Section: Evidence Summary Lactatementioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis

Cited by 43 publications

References 38 publications

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia

Ventriculostomy-related infections in subarachnoid hemorrhage patients—a retrospective study of incidence, etiology, and antimicrobial therapy

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

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