Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 4 ( 2018 ) > List of Articles

CASE REPORT

Cerebrospinal fluid lactate as a prognostic indicator in postneurosurgical bacterial meningitis and use of intrathecal colistin

Ipe Jacob, Pradeepkumar Hiremath

Keywords : Cerebrospinal fluid lactate, intrathecal colistin, postneurosurgery meningitis diagnosis

Citation Information : Jacob I, Hiremath P. Cerebrospinal fluid lactate as a prognostic indicator in postneurosurgical bacterial meningitis and use of intrathecal colistin. Indian J Crit Care Med 2018; 22 (4):297-299.

DOI: 10.4103/ijccm.IJCCM_418_17

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Postneurosurgical bacterial meningitis (PNBM) is an emergency and requires early diagnosis and treatment with appropriate antibiotics. The cornerstone of diagnosis is microbiological analysis of the cerebrospinal fluid (CSF) cytochemical characteristics such as leucocyte count, CSF glucose, and protein concentration and CSF: Serum glucose ratio. However, this is often misleading in PNBM. The role of CSF lactate assay for diagnosis and prognosis has been debated. This case report looks into the serial measurement of CSF lactates in PNBM. It also looks into the role of intrathecal colistin. CSF lactate showed a steady decrease corresponding to improvement in clinical condition. Hence, CSF lactate could have a better prognostic value than other conventional markers in PNBM. Intrathecal colistin, in conjunction with the standard antibiotics, can contribute to a quick resolution of the condition.


PDF Share
  1. Blomstedt GC. Infections in neurosurgery: A retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien) 1985;78:81-90.
  2. Ross D, Rosegay H, Pons V. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg 1988;69:669-74.
  3. 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;29:69-74.
  4. Genton B, Berger JP. Cerebrospinal fluid lactate in 78 cases of adult meningitis. Intensive Care Med 1990;16:196-200.
  5. Pavese P, Francois P, Lafond JL, Kay SS, Bosson JL. Assay of lactic acid in the cerebrospinal fluid for the diagnosis of bacterial meningitis. Strategies for the choice of discriminatory threshold. Presse Med 1997;26:551-4.
  6. van de Beek D, Drake JM, Tunkel AR. Nosocomial bacterial meningitis. N Engl J Med 2010;362:146-54.
  7. Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K, et al. Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: A systemic review and meta-analysis. Crit Care 2010;14:R240.
  8. Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis. J Infect 2011;62:255-62.
  9. Begovac J, Baće A, Soldo I, Lehpamer B. Lactate and glucose in cerebrospinal fluid heavily contaminated with blood. Acta Med Croatica 1991;45:341-5.
  10. Cameron PD, Boyce JM, Ansari BM. Cerebrospinal fluid lactate in meningitis and meningococcaemia. J Infect 1993;26:245-52.
  11. Bland RD, Lister RC, Ries JP. Cerebrospinal fluid lactic acid level and pH in meningitis. Aids in differential diagnosis. Am J Dis Child 1974;128:151-6.
  12. Kim BN, Peleg AY, Lodise TP, Lipman J, Li J, Nation R, et al. Management of meningitis due to antibiotic-resistant acinetobacter species. Lancet Infect Dis 2009;9:245-55.
  13. Vasen W, Desmery P, Ilutovich S, Di Martino A. Intrathecal use of colistin. J Clin Microbiol 2000;38:3523.
  14. Parenteral polymyxin B and colistimethate. JAMA 1977;237:1481-2.
  15. Rodríguez Guardado A, Blanco A, Asensi V, Pérez F, Rial JC, Pintado V, et al. Multidrug-resistant acinetobacter meningitis in neurosurgical patients with intraventricular catheters: Assessment of different treatments. J Antimicrob Chemother 2008;61:908-13.
  16. Lee CH, Tang YF, Su LH, Chien CC, Liu JW. Antimicrobial effects of varied combinations of meropenem, sulbactam, and colistin on a multidrug-resistant Acinetobacter baumannii isolate that caused meningitis and bacteremia. Microb Drug Resist 2008;14:233-7.
  17. Ho YH, Wang LS, Chao HJ, Chang KC, Su CF. Successful treatment of meningitis caused by multidrug-resistant Acinetobacter baumannii with intravenous and intrathecal colistin. J Microbiol Immunol Infect 2007;40:537-40.
  18. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267-84.
  19. Falagas ME, Bliziotis IA, Tam VH. Intraventricular or intrathecal use of polymyxins in patients with Gram-negative meningitis: A systematic review of the available evidence. Int J Antimicrob Agents 2007;29:9-25.
  20. 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;48:50-4.
  21. 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 2016;16:483.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.