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Zhang L, Zhang Y, Wang X, Zhao Y. Correlation of levels of lactic acid and glucose in cerebrospinal fluid of cerebral hemorrhage patients with the occurrence of postoperative intracranial infection and clinical prognosis. J Med Biochem 2024; 43:36-42. [PMID: 38496025 PMCID: PMC10943468 DOI: 10.5937/jomb0-44058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/11/2023] [Indexed: 03/19/2024] Open
Abstract
Background Cerebral haemorrhage is a critical condition that often requires surgical treatment, and postoperative intracranial infection can significantly impact patient outcomes. The aim of the study was to examine the relationship between the levels of lactic acid and glucose in cerebrospinal fluid (CSF) of patients with cerebral haemorrhage and their postoperative intracranial infection and clinical prognosis. Methods The study selected the clinical data of 324 patients with cerebral haemorrhage who underwent surgical treatment in our hospital from March 2020 to March 2022 for retrospective analysis and divided these patients into the intracranial infection group (Group A, n=22, leukocyte values in CSF>5×106/L) and the non-intracranial infection group (Group B, n=302, leukocyte values in CSF 5×106/L) according to the occurrence of postoperative intracranial infection in patients to detect the levels of lactic acid and glucose in CSF at different times in the two groups. Pearson method was adopted to analyze the correlation of the levels of lactic acid and glucose in CSF of patients with intracranial infection, and the Glasgow Outcome Scale (GOS) was used to assess the clinical prognosis of patients. According to their scores, these patients were divided into the good prognosis group (GPG, scores of 4-5 points, n=178) and the poor prognosis group (PPG, scores of 1-3 points, n=146). The levels of lactic acid and glucose in the CSF of patients in the two groups were measured, and the Pearson method was adopted to analyze the relationship between these levels and clinical prognosis.
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Affiliation(s)
- Lei Zhang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Yan Zhang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Xiaotian Wang
- Dongying Peoples Hospital, Department of Emergency Critical Care Medicine, Dongying, China
| | - Yun Zhao
- Dongying Peoples Hospital, Administration Department of Nosocomial Infection Dongying, China
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Balamuth F, Cruz AT, Freedman SB, Ishimine PT, Garro A, Curtis S, Grether-Jones KL, Miller AS, Uspal NG, Schmidt SM, Shah SS, Nigrovic LE. Test Characteristics of Cerebrospinal Fluid Gram Stain to Identify Bacterial Meningitis in Infants Younger Than 60 Days. Pediatr Emerg Care 2021; 37:e227-e229. [PMID: 30422943 DOI: 10.1097/pec.0000000000001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In our cohort of 20,947 infants aged 60 days or younger, cerebrospinal fluid Gram stain had a sensitivity of 34.3% (95% confidence interval, 28.1%-41.1%) and a positive predictive value of 61.4% (95% confidence interval, 52.2%-69.8%) for positive cerebrospinal fluid culture, suggesting that Gram stain alone may lead to both underdiagnosis and overdiagnosis of bacterial meningitis.
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Affiliation(s)
- Fran Balamuth
- From the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Andrea T Cruz
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor School of Medicine, Houston, TX
| | - Stephen B Freedman
- Division of Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Paul T Ishimine
- Departments of Emergency Medicine and Pediatrics, University of California, San Diego School of Medicine, San Diego, CA
| | - Aris Garro
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Sarah Curtis
- Division of Pediatric Emergency Medicine, Stollery Children's Hospital, Women and Children's Health Research Institute & Faculty of Medicine & Dentistry, University of Alberta, Canada
| | | | - Aaron S Miller
- Division of Pediatric Infectious Diseases, St. Louis University School of Medicine, St. Louis, MO
| | - Neil G Uspal
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Suzanne M Schmidt
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, Chicago, IL
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lise E Nigrovic
- Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Zea-Vera A, Turín CG, Rueda MS, Guillén-Pinto D, Medina-Alva P, Tori A, Rivas M, Zegarra J, Castañeda A, Cam L, Ochoa TJ. [Use of lumbar puncture in the evaluation of late-onset sepsis in low birth weight neonates]. Rev Peru Med Exp Salud Publica 2016; 33:278-282. [PMID: 27656928 PMCID: PMC5544347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 05/04/2016] [Indexed: 06/06/2023] Open
Abstract
The objective of this study was to analyze the use of lumbar punctures (LP) in the evaluation of late-onset neonatal sepsis. It is recommended to perform an LP as part of the evaluation of late-onset sepsis. We used a cohort of 414 newborns with a birth weight <2000g in three hospitals in Lima. A LP was performed in 45/214 (21.0%) of sepsis evaluations and in 13/48 (27.1%) of culture-proven sepsis. Meningitis was diagnosed in 8/214 (3.7%) of the episodes and 8/45 (17.5%) of the evaluations that included an LP. The duration of treatment of the sepsis episodes without a LP and the episodes with a negative LP was similar, and shorter than the episodes with a positive LP. The use of LP in the evaluation of late-onset sepsis is low and can result in undiagnosed and undertreated meningitis. The use of LP in the evaluation of neonatal sepsis must be encouraged in the neonatal units.
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Kaul V, Harish R, Ganjoo S, Mahajan B, Raina SK, Koul D. Importance of obtaining lumbar puncture in neonates with late onset septicemia a hospital based observational study from north-west India. J Clin Neonatol 2013; 2:83-7. [PMID: 24049750 PMCID: PMC3775142 DOI: 10.4103/2249-4847.116407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study was to estimate the prevalence of meningitis in cases with late onset septicemia (LOS). MATERIALS AND METHODS A prospective study was carried out for a period of 1 year in a tertiary care hospital in North West India to estimate the prevalence of meningitis in cases of LOS. In all the admitted neonates with features of sepsis with a positive C-reactive protein, a lumbar puncture (LP) was carried out and results interpreted on the basis of cerebrospinal fluid (CSF) cytology and biochemistry. Simultaneous blood and CSF cultures were also taken. All other baseline investigations were performed and in those diagnosed as meningitis an ultrasound head was carried out prior to discharge. No urine cultures were obtained. RESULTS The study showed the prevalence of meningitis as 22.5% in neonates with LOS with statistically significant implications of meningitis versus gestation, sex, acquired the place of infection, and outcome in terms of sequelae/mortality. CONCLUSIONS Meningitis is commonly associated with late onset sepsis hence LP should be the standard of care in such neonates as the treatment protocol and the outcome is directly proportional to the diagnosis at initial presentation.
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Affiliation(s)
- Varun Kaul
- Department of Pediatrics, Government Medical College, Jammu, Jammu and Kashmir, India
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Cerebrospinal fluid enrichment broth cultures rarely contribute to the diagnosis of bacterial meningitis. Pediatr Infect Dis J 2012; 31:318-20. [PMID: 22315003 DOI: 10.1097/inf.0b013e318243e502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study included children undergoing lumbar puncture in the emergency department. Bacteria were isolated from 34 (1.7%) of 1898 cerebrospinal fluid (CSF) enrichment broth cultures; 30 were contaminants. The primary CSF Gram stain was negative in all specimens with a positive enrichment broth culture. Enrichment broth cultures rarely contributed to the diagnosis of bacterial meningitis, and positive CSF enrichment broth cultures contributed to diagnostic uncertainty.
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Diagnostic accuracy of cerebrospinal fluid gram stain in children with suspected bacterial meningitis. Pediatr Infect Dis J 2012; 31:195-7. [PMID: 22094629 DOI: 10.1097/inf.0b013e31823d7b6f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This cross-sectional study included 1938 children undergoing lumbar puncture; 21 (1.1%) cases were classified as definite (n = 17) or probable (n = 4) bacterial meningitis. Gram stain sensitivity was 94.1% (95% confidence interval, 71.3%-99.9%) for those with definite meningitis; the positive predictive value was 47.1% (95% confidence interval, 29.8%-64.9%). The sensitivity was 95.2% for those with definite or probable meningitis. Antibiotic pretreatment did not affect results.
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Sharma B, Gupta S, Jain N, Handoo A, Sood J. Cerebrospinal fluid cytology in patients undergoing combined spinal epidural versus spinal anaesthesia without an introducer. Anaesth Intensive Care 2011; 39:914-8. [PMID: 21970139 DOI: 10.1177/0310057x1103900518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. Seven patients were excluded from the study and the rest divided into two groups to receive either combined spinal epidural anaesthesia (group A) or isolated subarachnoid anaesthesia, unaided by an introducer (group B). The two groups were compared for the presence of epithelial cells in cerebrospinal fluid. The initial four to six drops of cerebrospinal fluid (sample 1) were collected, the next four to six drops discarded and the following four to six drops (sample 2) collected. The incidence of coring was 96% in group A and 88% in group B (P = 0.142). The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.
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Affiliation(s)
- B Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India.
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Enrichment culture of CSF is of limited value in the diagnosis of neonatal meningitis. Eur J Clin Microbiol Infect Dis 2011; 30:931-3. [DOI: 10.1007/s10096-011-1163-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Few data exist regarding the test characteristics of cerebrospinal fluid (CSF) Gram stain among children at risk for bacterial meningitis, especially the rate of false positive Gram stain. METHODS We conducted a retrospective cohort study of children seen in the emergency department of Children's Hospital Boston who had CSF obtained between December 1992 and September 2005. Patients who had ventricular shunts, as well as those who received antibiotics before CSF was obtained were excluded. Test characteristics of CSF Gram stain were assessed using CSF culture as the criterion standard. Patients were considered to have bacterial meningitis if there was either: (1) growth of a pathogen, or (2) growth of a possible pathogen noted on the final CSF culture report and the patient was treated with a course of parenteral antibiotics for 7 days or more without other indication. RESULTS A total of 17,569 eligible CSF specimens were collected among 16,036 patients during the 13-year study period. The median age of study subjects was 74 days. Seventy CSF specimens (0.4%) had organisms detected on Gram stain. The overall sensitivity of Gram stain to detect bacterial meningitis was 67% [42 of 63; 95% confidence interval (CI): 54-78] with a positive predictive value of 60% (42 of 70; 95% CI: 48-71). Most patients without bacterial meningitis have negative Gram stain [specificity 99.9% (17,478 of 17,506; 95% CI: 99.8-99.9)] with a negative predictive value of 99.9 (17,478 of 17,499; 95% CI: 99.8-99.9). CONCLUSIONS CSF Gram stain is appropriately used by physicians in risk stratification for the diagnosis and empiric treatment of bacterial meningitis in children. Although a positive Gram stain result greatly increases the likelihood of bacterial meningitis; the result may be because of contamination or misinterpretation in 40% of cases and should not, by itself, result in a full treatment course for bacterial meningitis.
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Abstract
Infections of the mother, the intrauterine environment, the fetus, and the neonate can cause cerebral palsy through a variety of mechanisms. Each of these processes is reviewed. The recently proposed theory of cytokine-induced white matter brain injury and the systemic inflammatory response syndrome with multiple organ dysfunction syndrome is critically evaluated.
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Affiliation(s)
- Marcus C Hermansen
- Department of Pediatrics, Dartmouth Medical School, Lebanon, NH 03756-0001, USA.
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Affiliation(s)
- K Malbon
- Neonatal Unit, Northwick Park Hospital, Harrow HA1 3UJ, UK
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Nigrovic LE, Kuppermann N, Malley R. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics 2002; 110:712-9. [PMID: 12359784 DOI: 10.1542/peds.110.4.712] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children with meningitis are routinely admitted to the hospital and administered broad-spectrum antibiotics pending culture results because distinguishing bacterial meningitis from aseptic meningitis is often difficult. OBJECTIVE To develop and validate a simple multivariable model to distinguish bacterial meningitis from aseptic meningitis in children using objective parameters available at the time of patient presentation. DESIGN Retrospective cohort study of all children with meningitis admitted to 1 urban children's hospital from July 1992 through June 2000, randomly divided into derivation (66%) and validation sets (34%). PATIENTS Six hundred ninety-six previously healthy children aged 29 days to 19 years, of whom 125 (18%) had bacterial meningitis and 571 (82%) had aseptic meningitis. INTERVENTION Multivariable logistic regression and recursive partitioning analyses identified the following predictors of bacterial meningitis from the derivation set: Gram stain of cerebrospinal fluid (CSF) showing bacteria, CSF protein > or =80 mg/dL, peripheral absolute neutrophil count > or =10 000 cells/mm3, seizure before or at time of presentation, and CSF absolute neutrophil count > or =1000 cells/mm3. A Bacterial Meningitis Score (BMS) was developed on the derivation set by attributing 2 points for a positive Gram stain and 1 point for each of the other variables. MAIN OUTCOME MEASURE The accuracy of the BMS when applied to the validation set. RESULTS A BMS of 0 accurately identified patients with aseptic meningitis without misclassifying any child with bacterial meningitis in the validation set. The negative predictive value of a score of 0 for bacterial meningitis was 100% (95% confidence interval: 97%-100%). A BMS > or =2 predicted bacterial meningitis with a sensitivity of 87% (95% confidence interval: 72%-96%). CONCLUSIONS The BMS accurately identifies children at low (BMS = 0) or high (BMS > or =2) risk of bacterial meningitis. Outpatient management may be considered for children in the low-risk group.
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Affiliation(s)
- Lise E Nigrovic
- Department of Medicine, Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Parks DK, Yetman RJ, Moyer V, Kennedy K. Early-onset neonatal group B streptococcal infection: implications for practice. J Pediatr Health Care 2000; 14:264-9. [PMID: 11112918 DOI: 10.1067/mph.2000.106395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Group B streptococcus (GBS) is the leading bacterial infection associated with morbidity and mortality of newborns in the United States. Most neonatal infections can be prevented through the use of intrapartum antimicrobial prophylaxis in women who are at increased risk for transmitting infection to their newborns. However, prevention strategies have not been implemented widely or consistently, and the incidence of neonatal GBS disease has not declined. An understanding of GBS epidemiology, clinical presentation, and prevention strategies enhances the PNP's decision-making skills in the nursery and strengthens the PNP's ability to evaluate and compare new approaches to GBS prevention.
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MESH Headings
- Antibiotic Prophylaxis
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/nursing
- Infant, Newborn, Diseases/prevention & control
- Infectious Disease Transmission, Vertical/prevention & control
- Nurse Practitioners
- Nursing Assessment
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/nursing
- Pregnancy Complications, Infectious/prevention & control
- Streptococcal Infections/epidemiology
- Streptococcal Infections/nursing
- Streptococcal Infections/prevention & control
- Streptococcus agalactiae
- United States/epidemiology
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Affiliation(s)
- D K Parks
- Medical School Health Services, University of Texas-Houston Medical School 77030, USA
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Abstract
Neonatal bacterial meningitis is a serious disease around the world, with the incidence changing little in the past 30 years. Group B streptococci, Escherichia coli, and Klebsiella pneumoniae are common causative organisms and lumbar puncture remains the definitive method of diagnosis. The mortality rate has declined in industrialized countries over the years, from almost 50% in the 1970s to less than 10% in 1997. However, neurological sequelae are still frequently observed despite major changes in treatment. Preliminary analysis of our own data from a prospective study of cases in the United Kingdom suggests that treatment with third generation cephalosporins is related to a decrease in mortality but not morbidity.
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Affiliation(s)
- D Harvey
- Karim Centre for Meningitis Research, ICSM Department of Paediatrics and Neonatal Medicine, Queen Charlotte's and Chelsea Hospital, London, England
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Lessing MP, Bowler IC. The value of cerebrospinal fluid enrichment culture in the diagnosis of acute bacterial meningitis. Eur J Clin Microbiol Infect Dis 1996; 15:79-82. [PMID: 8641310 DOI: 10.1007/bf01586191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The records of cerebrospinal fluid (CSF) examinations for the three-year period ending 30 September 1991 were studied retrospectively. From 3,161 examinations, 66 pathogens were detected, 64 of which were from primary agar plate culture. Enrichment broth culture yielded 219 isolates of which 217 were likely contaminants. Only two pathogens were isolated by enrichment, and in both samples the CSF leucocyte counts were abnormal. The use of enrichment broth culture should be confined to CSF specimens with abnormal leucocyte counts and/or Gram stains.
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Affiliation(s)
- M P Lessing
- Department of Medical Microbiology, John Radcliffe Hospital, Oxford, UK
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