title: Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery.
abstract: The value of cerebrospinal fluid (CSF) lactate level and CSF/blood glucose ratio for the identification of bacterial meningitis following neurosurgery was assessed in a retrospective study. During a 3-year period, 73 patients fulfilled the inclusion criteria and could be grouped by preset criteria in one of three categories: proven bacterial meningitis (n = 12), presumed bacterial meningitis (n = 14), and nonbacterial meningeal syndrome (n = 47). Of 73 patients analyzed, 45% were treated with antibiotics and 33% with steroids at the time of first lumbar puncture. CSF lactate values (cutoff, 4 mmol/L), in comparison with CSF/blood glucose ratios (cutoff, 0.4), were associated with higher sensitivity (0.88 vs. 0.77), specificity (0.98 vs. 0.87), and positive (0.96 vs. 0.77) and negative (0.94 vs. 0.87) predictive values. In conclusion, determination of the CSF lactate value is a quick, sensitive, and specific test to identify patients with bacterial meningitis after neurosurgery.
authors.affiliation: Division of Infectious Diseases and the Clinic of Neurosurgery, University Hospitals Basel, Switzerland. sleib@imm.unibe.ch
authors.forename: S L
authors.initials: SL
authors.lastname: Leib
authors.forename: R
authors.initials: R
authors.lastname: Boscacci
authors.forename: O
authors.initials: O
authors.lastname: Gratzl
authors.forename: W
authors.initials: W
authors.lastname: Zimmerli
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D006801:Humans; D007773:Lactates / Q000134:cerebrospinal fluid*; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007773:Lactates; D005947:Glucose