title: Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis.
abstract: 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.
authors.affiliation: Children's Hospital Boston and Harvard Medical School,, Boston, MA 02115, USA. lise.nigrovic@childrens.harvard.edu
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.forename: Richard
authors.initials: R
authors.lastname: Malley
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: John T
authors.initials: JT
authors.lastname: Kanegaye
authors.forename: Donna M
authors.initials: DM
authors.lastname: Moro-Sutherland
authors.forename: Robert D
authors.initials: RD
authors.lastname: Schremmer
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Schwab
authors.forename: Dewesh
authors.initials: D
authors.lastname: Agrawal
authors.forename: Karim M
authors.initials: KM
authors.lastname: Mansour
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Bennett
authors.forename: Yiannis L
authors.initials: YL
authors.lastname: Katsogridakis
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mohseni
authors.forename: Blake
authors.initials: B
authors.lastname: Bulloch
authors.forename: Dale W
authors.initials: DW
authors.lastname: Steele
authors.forename: Ron L
authors.initials: RL
authors.lastname: Kaplan
authors.forename: Martin I
authors.initials: MI
authors.lastname: Herman
authors.forename: Subhankar
authors.initials: S
authors.lastname: Bandyopadhyay
authors.forename: Peter
authors.initials: P
authors.lastname: Dayan
authors.forename: Uyen T
authors.initials: UT
authors.lastname: Truong
authors.forename: Vince J
authors.initials: VJ
authors.lastname: Wang
authors.forename: Bema K
authors.initials: BK
authors.lastname: Bonsu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Chapman
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D011506:Proteins; D005947:Glucose