CSF lactate for accurate diagnosis of community-acquired bacterial meningitis.
CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. Stefano.Giulieri@chuv.ch.
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Giulieri
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Chapuis-Taillard
Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Jaton
Internal Medicine Service, Regional Hospital, Yverdon, Switzerland.
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Cometta
Internal Medicine Service, Cantonal Hospital, Fribourg, Switzerland.
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Chuard
Emergency Medicine Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Hugli
Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Du Pasquier
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.|Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Bille
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.|Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Meylan
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Manuel
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Marchetti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood* / Q000175:diagnosis*; D008587:Meningitis, Viral / Q000097:blood* / Q000175:diagnosis*; D008875:Middle Aged; D011446:Prospective Studies; D016184:Receptors, Colony-Stimulating Factor / Q000097:blood*; D012680:Sensitivity and Specificity; D013557:Switzerland; D055815:Young Adult
D016184:Receptors, Colony-Stimulating Factor; D019344:Lactic Acid