title: Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults.
abstract: Microbiological tests on cerebrospinal fluid (CSF) utilize a common urgent-care procedure that does not take into account the chemical and cytological characteristics of the CSF, resulting sometimes in an unnecessary use of human and diagnostic resources. The aim of this study was to retrospectively validate a simple scoring system (bacterial meningitis-Careggi score [BM-CASCO]) based on blood and CSF sample chemical/cytological parameters for evaluating the probability of acute bacterial meningitis (ABM) in adults. BM-CASCO (range, 0 to 6) was defined by the following parameters: CSF cell count, CSF protein levels, CSF lactate levels, CSF glucose-to-serum glucose ratio, and peripheral neutrophil count. BM-CASCO was retrospectively calculated for 784 cases of suspected ABM in adult subjects observed during a four-and-a-half-year-period (2010 to 2014) at the emergency department (ED) of a large tertiary-care teaching hospital in Italy. Among the 28 confirmed ABM cases (3.5%), Streptococcus pneumoniae was the most frequent cause (16 cases). All ABM cases showed a BM-CASCO value of ≥3. Most negative cases (591/756) exhibited a BM-CASCO value of ≤1, which was adopted in our laboratory as a cutoff to not proceed with urgent microbiological analysis of CSF in cases of suspected ABM in adults. During a subsequent 1-year follow-up, the introduction of the BM-CASCO in the diagnostic workflow of ABM in adults resulted in a significant decrease in unnecessary microbiological analysis, with no false negatives. In conclusion, BM-CASCO appears to be an accurate and simple scoring system for optimization of the microbiological diagnostic workflow of ABM in adults.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lagi
authors.affiliation: Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Bartalesi
authors.affiliation: Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pecile
authors.affiliation: General Laboratory, Careggi University Hospital, Florence, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Biagioli
authors.affiliation: General Laboratory, Careggi University Hospital, Florence, Italy.
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Caldini
authors.affiliation: General Laboratory, Careggi University Hospital, Florence, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fanelli
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giannazzo
authors.affiliation: Department of Emergency Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Division Neurology 2, Careggi University Hospital, Florence, Italy.|Department of Neurosciences, University of Florence, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Massacesi
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.|Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy gianmaria.rossolini@unifi.it.|Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy.|Department of Medical Biotechnologies, University of Siena, Siena, Italy.|Don Carlo Gnocchi Foundation, Florence, Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001773:Blood Cells; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology; D019411:Clinical Laboratory Techniques / Q000379:methods*; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D007958:Leukocyte Count; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D008875:Middle Aged; D012189:Retrospective Studies; D057188:Workflow; D055815:Young Adult