Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE 3 ( March, 2019 ) > List of Articles

ORIGINAL ARTICLE

Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis

Rebai Lotfi, Boussaidi Ines, Daghmouri M Aziz, Badri Mohamed

Keywords : bacterial meningitis, neurosurgical, CSF lactate

Citation Information : Lotfi R, Ines B, Aziz DM, Mohamed B. Cerebrospinal Fluid Lactate as an Indicator for Post-Neurosurgical Bacterial Meningitis. Indian J Crit Care Med 2019; 23 (3):127-130.

DOI: 10.5005/jp-journals-10071-23134

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: To evaluate the interest of cerebrospinal fluid (CSF) lactate assay for the diagnosis of post-neurosurgical bacterial meningitis (PBM). Methods: We conducted at our neurosurgical resuscitation unit a prospective study of patients who underwent elective or emergency craniotomy. Lumbar puncture was performed in all patients who had clinical suspicion of PBM for CSF culture and cytological and chemical analysis (glucose, protein, lactate). The diagnosis of PBM is made according to the criteria proposed by the Center for Disease Control and Prevention (CDC). Receiver Operating Characteristic (ROC) was used to determine the diagnostic accuracy of CSF lactate. Results: 72 patients were studied and only 32 of them had the clinical and biological criteria of the diagnosis of PBM. Median CSF lactate was 6.18 mmol/L for PBM versus 2.63 mmol/L for no PBM (p < 0.001). CSF lactate may predict the presence PBM, with a AUC of 0.98 and NPV of 99.1. The analysis of Youden\'s index also confirms the good diagnostic power of CSF lactate, with a value of 83 at a cut-off value of 4 mmol/L, with a sensitivity of 92.3 and specificity of 91.6%. Conclusion: Our study shows that the CSF lactate as an indicator for PBM. It is a fast and simple test that can help the clinician to optimize the management of PBM and decrease premature cessation of antibiotics.


PDF Share
  1. Blomstedt GC. Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir 1985;78(3 4):81 90.
  2. Leib SL, Boscacci R, Gratzl O, Zimmerli W. Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clin Infect Dis 1999;29(1):69 74.
  3. Zarrouk V, Vassor I, Bert F, Bouccara D, Kalamarides M, Bendersky N, et al. Evaluation of the management of postoperative aseptic meningitis. Clin Infect Dis 2007;44(12):1555 9.
  4. Wang K-W, Chang W-N, Huang C-R, Tsai N-W, Tsui H-W, Wang H-C, et al. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci 2005;12(6):647 50. 5 Druel B, Vandenesch F, Greenland T, Verneau V, Grando J, Salord F, et al. Aseptic meningitis after neurosurgery: a demonstration of bacterial involvement. Clin Microbiol Infect 1996;1(4):230 4.
  5. van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 14 2010;362(2):146 54.
  6. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309 32.
  7. Simon TD, Pope CE, Browd SR, Ojemann JG, Riva-Cambrin J, Mayer-Hamblett N, et al. Evaluation of microbial bacterial and fungal diversity in cerebrospinal fluid shunt infection. PLoS ONE 2014;9(1):e83229.
  8. Lai W-A, Lu C-H, Chang W-N. Mixed infection in adult postneurosurgical bacterial meningitis: a hospital-based study. Biomed J2013;36(6):295 303.
  9. Grille P, Torres J, Porcires F, Bagnulo H. Value of cerebrospinal fluid lactate for the diagnosis of bacterial meningitis in postoperative neurosurgical patients. Neurocirugia 2012;23(4):131 5.
  10. Maskin LP, Capparelli F, Mora A, Hlavnicka A, Orellana N, Díaz MF, et al. Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg 2013;115(9):1820 5.
  11. Li Y, Zhang G, Ma R, Du Y, Zhang L, Li F, et al. The diagnostic value of cerebrospinal fluids procalcitonin and lactate for the differential diagnosis of post-neurosurgical bacterial meningitis and aseptic meningitis. Clin Biochem 2015;48(1 2):50 4.
  12. Hussein K, Bitterman R, Shofty B, Paul M, Neuberger A. Management of post-neurosurgical meningitis: narrative review. Clin Microbiol Infect 2017;23(9):621 8.
  13. Tamune H, Takeya H, Suzuki W, Tagashira Y, Kuki T, Honda H, et al. Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis. Am J Emerg Med 2014;32(3):263 6.
  14. Beer R, Pfausler B, Schmutzhard E. Management of nosocomial external ventricular drain-related ventriculomeningitis. Neurocrit Care 2009;10(3):363 7.
  15. De Sanctis AG, Garcia T. Lactic acid of spinal fluid meningitis. Am J Dis Child 1933;46:239-49.
  16. Xiao X, Zhang Y, Zhang L, Kang P, Ji N. The diagnostic value of cerebrospinal fluid lactate for post-neurosurgical bacterial meningitis: a meta-analysis. BMC Infect Dis 13 2016;16:483.
  17. Gray LD, Fedorko DP. Laboratory diagnosis of bacterial meningitis. Clin Microbiol Rev 1992;5(2):130 45.
  18. Knudsen TB, Larsen K, Kristiansen TB, Møller HJ, Tvede M, Eugen-Olsen J, et al. Diagnostic value of soluble CD163 serum levels in patients suspected of meningitis: comparison with CRP and procalcitonin. Scand J Infect Dis 2007;39(6 7):542 53.
  19. McClelland S, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 2007;45(1):55 9.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.