title: Multicenter testing of the rapid quantification of radical oxygen species in cerebrospinal fluid to diagnose bacterial meningitis.
abstract: OBJECTIVE
  Meningitis is a serious concern after traumatic brain injury (TBI) or neurosurgery. This study tested the level of reactive oxygen species (ROS) in cerebrospinal fluid (CSF) to diagnose meningitis in febrile patients several days after trauma or surgery.
  
  
  METHODS
  Febrile patients (temperature > 38°C) after TBI or neurosurgery were included prospectively. ROS were measured in CSF within 4 hours after sampling using luminescence in the basal state and after cell stimulation with phorbol 12-myristate 13-acetate (PMA). The study was conducted in a single-center cohort 1 (n = 54, training cohort) and then in a multicenter cohort 2 (n = 136, testing cohort) in the Intensive Care and Neurosurgery departments of two teaching hospitals. The performance of the ROS test was compared with classical CSF criteria, and a diagnostic decision for meningitis was made by two blinded experts.
  
  
  RESULTS
  The production of ROS was higher in the CSF of meningitis patients than in non-infected CSF, both in the basal state and after PMA stimulation. In cohort 1, ROS production was associated with a diagnosis of meningitis with an AUC of 0.814 (95% confidence interval (CI) [0.684-0.820]) for steady-state and 0.818 (95% CI [0.655-0.821]) for PMA-activated conditions. The best threshold value obtained in cohort 1 was tested in cohort 2 and showed high negative predictive values and low negative likelihood ratios of 0.94 and 0.36 in the basal state, respectively, and 0.96 and 0.24 after PMA stimulation, respectively.
  
  
  CONCLUSIONS
  The ROS test in CSF appeared suitable for eliminating a diagnosis of bacterial meningitis.
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Lukaszewicz
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Faivre
authors.affiliation: Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Bout
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Tina
authors.initials: T
authors.lastname: Lagergren
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Damoisel
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam
authors.affiliation: Department of Anesthesiology and Critical Care, Beaujon Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.affiliation: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
mesh_terms: D001930:Brain Injuries / Q000134:cerebrospinal fluid* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000209:etiology; D017382:Reactive Oxygen Species / Q000134:cerebrospinal fluid*
chemical_list: D017382:Reactive Oxygen Species