Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis.
OBJECTIVE
The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis.


METHODS
We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture.


RESULTS
We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with >or=12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for <12 hours, had significantly higher median cerebrospinal fluid glucose levels (48 mg/dL vs 29 mg/dL) and lower median cerebrospinal fluid protein levels (121 vs 178 mg/dL).


CONCLUSIONS
In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.
Nigrovic
Lise E
LE
Children's Hospital Boston and Harvard Medical School,, Boston, MA 02115, USA. lise.nigrovic@childrens.harvard.edu
Malley
Richard
R
Macias
Charles G
CG
Kanegaye
John T
JT
Moro-Sutherland
Donna M
DM
Schremmer
Robert D
RD
Schwab
Sandra H
SH
Agrawal
Dewesh
D
Mansour
Karim M
KM
Bennett
Jonathan E
JE
Katsogridakis
Yiannis L
YL
Mohseni
Michael M
MM
Bulloch
Blake
B
Steele
Dale W
DW
Kaplan
Ron L
RL
Herman
Martin I
MI
Bandyopadhyay
Subhankar
S
Dayan
Peter
P
Truong
Uyen T
UT
Wang
Vince J
VJ
Bonsu
Bema K
BK
Chapman
Jennifer L
JL
Kuppermann
Nathan
N
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification*; D015415:Biomarkers / Q000378:metabolism; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000378:metabolism / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005947:Glucose / Q000134:cerebrospinal fluid; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid / Q000209:etiology; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000150:complications / Q000188:drug therapy; D011506:Proteins / Q000378:metabolism; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013129:Spinal Puncture; D014481:United States
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D011506:Proteins; D005947:Glucose