Management of acute community-acquired bacterial meningitis (excluding newborns). Long version with arguments

Community-acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort

“…Distribution of causative microorganisms was close to those of French surveillance data over the same study period [22] and consistent with that reported in the literature [2,3,5,23] with S. pneumoniae the most common pathogen followed by N. meningitidis. Pneumococcal meningitis due to serotypes in currently available vaccines (7-, 13-and 23-valent pneumococcal vaccines) represented >60% of all pneumococcal meningitis.…”

<p>Management of Acute Bacterial Meningitis in Children</p>

“…An LP for cerebrospinal fluid (CSF) analysis and culture remains key for diagnosis. 21,28 Characteristic CSF findings for bacterial meningitis consist of polymorphonuclear pleocytosis (WBC >1000 Cells/µL, 80-90% polymorphonuclear cells), hypoglycorrachia (CSF glucose <40 mg/dL, a ratio of CSF to serum glucose of ≤0.4 in children and ≤0.6 in term neonates) and elevated CSF protein levels >150 mg/dL. 21,29,30 In the pediatric population, CSF indexes vary with age, with poorly defined normal values especially in infants.…”

“…They are cheap and well-validated tools but the sensitivity varies by different age groups, types of meningeal pathogens and by the use of previous antibiotic therapy. [26][27][28][29][30][31] The sensitivity of the Gram stain in neonates is ~60% 31 while in children it ranges from 50% to 63%. 32,33 The sensitivity also ranges by pathogen: 90% in S. pneumoniae meningitis, 34,35 80% in N. meningitides, 50% in Gram-negative bacillary meningitis, and 30% in L. monocytogenes.…”

Assessment of a Multiplex LAMP Assay (Eazyplex® CSF Direct M) for Rapid Molecular Diagnosis of Bacterial Meningitis: Accuracy and Pitfalls

“…Positive biological criteria for bacterial meningitis were defined as (i) a positive CSF culture to one of the pathogens included in the EP, and/or (ii) CSF parameters indicative of infection (i.e., the association of WBC count of ≥ 5 cells/µL and protein concentration ≥ 0.5 g/L, and either (i) CSF glucose level ≤ 60% of blood glucose level or CSF glucose level < 2.6 mM (for newborns ≤ 2 months) or (ii) CSF glucose level ≤ 40% of blood glucose level or CSF glucose level < 2.6 mM (for children > 2 months and adults), according to the 2018 French infectious diseases society (French acronym SPILF) recommendations and the 2004 Infectious Diseases Society of America guidelines [ 3 , 7 ]).…”

“…Early identification of the etiological infectious agent is helpful to optimize first-line treatments. Therefore, French and European guidelines recommend the use of molecular methods (i) whenever possible when bacterial meningitis is strongly suspected and the direct examination is negative, and (ii) when Microorganisms 2021, 9, 1859 2 of 11 the direct examination is positive and the culture remains negative at 24 h [3,4]. In that context, multiplex syndromic panel-based molecular approaches present attractive features, including the need for only a small volume of cerebrospinal fluid (CSF), the ease of use, and the low turnaround time [5].…”