Predictors of bacterial meningitis in the era after Haemophilus influenzae.
OBJECTIVE
To determine if, in the era after Haemophilus influenzae type b, the cerebrospinal fluid (CSF) white blood cell (WBC) count can be safely used to stratify children suspected of having bacterial meningitis into low- and high-risk groups.


METHODS
Retrospective analysis of CSF samples.


METHODS
Tertiary care pediatric center in Toronto, Ontario, between January 1, 1992, and October 1, 1996.


METHODS
All CSF samples collected on children aged 2 months to 17 years were included. The final database consisted of 1617 atraumatic samples from children without prior neurologic or immunologic disease who underwent a lumbar puncture to assess the possibility of community-acquired bacterial meningitis.


METHODS
The predictive values of CSF WBC count, differential, protein, and glucose.


RESULTS
There were 44 cases of bacterial meningitis. Five had 3 CSF WBCs per microliter or less, and 6 had 4 to 30 CSF WBCs per microliter. The negative predictive value of CSF specimens with 30 WBCs per microliter or less for bacterial meningitis was 99.3%. Cerebrospinal fluid samples with greater than 30 WBCs per microliter had a likelihood ratio for bacterial meningitis of 10.3 (95% confidence interval, 8.0-13.1) and a positive predictive value of 22.3%. Other significant predictors of bacterial meningitis included age, CSF glucose, protein, gram stain, CSF-serum glucose ratio, and peripheral blood band count.


CONCLUSIONS
Given the occurrence of bacterial meningitis in children in the absence of CSF pleocytosis, other factors should be considered when managing children with suspected bacterial meningitis. Children older than 6 months with 30 CSF WBCs per microliter or less are at low risk for bacterial meningitis. If clinically stable and without other laboratory markers of bacterial meningitis, hospital admission and empiric antibiotic therapy may be unwarranted.
Freedman
S B
SB
Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario.
Marrocco
A
A
Pirie
J
J
Dick
P T
PT
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D018073:Haemophilus Vaccines / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013129:Spinal Puncture; D013997:Time Factors
D018073:Haemophilus Vaccines; D005947:Glucose