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Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study
BACKGROUND: Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. M...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181581/ https://www.ncbi.nlm.nih.gov/pubmed/32326881 http://dx.doi.org/10.1186/s12879-020-05022-6 |
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author | Dittrich, Tolga Marsch, Stephan Egli, Adrian Rüegg, Stephan De Marchis, Gian Marco Tschudin-Sutter, Sarah Sutter, Raoul |
author_facet | Dittrich, Tolga Marsch, Stephan Egli, Adrian Rüegg, Stephan De Marchis, Gian Marco Tschudin-Sutter, Sarah Sutter, Raoul |
author_sort | Dittrich, Tolga |
collection | PubMed |
description | BACKGROUND: Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. METHODS: Consecutive patients with meningitis and/or encephalitis form 2011–17 at a Swiss academic medical care center were included in this cross-sectional study. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. Infectious meningitis and/or encephalitis were defined as the composite outcome. For diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Multinomial logistic regression was performed to identify predictors of the composite outcome. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. An AUROC between 0.7–0.8 was defined as “good”, 08–0.9 as “excellent”, and > 0.9 as “outstanding”. Calibration was defined as “good” if the goodness of fit tests revealed insignificant p-values. RESULTS: Among 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Most frequent infectious pathogens were Streptococcus pneumoniae, Varicella zoster, and Herpes simplex 1&2. While in multivariable analysis lactate concentrations and decreased glucose ratios were the only independent predictors of bacterial infection (AUROCs 0.780, 0.870, and 0.834 respectively), increased CSF mononuclear cells were the only predictors of viral infections (AUROC 0.669). All predictors revealed good calibration. CONCLUSIONS: Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. While increased CSF lactate and decreased glucose ratio are is the most reliable predictors of bacterial infections in patients with meningitis and/or encephalitis, only mononuclear cell counts predicted viral infections. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03856528. Registered on February 26th 2019. |
format | Online Article Text |
id | pubmed-7181581 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-71815812020-04-28 Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study Dittrich, Tolga Marsch, Stephan Egli, Adrian Rüegg, Stephan De Marchis, Gian Marco Tschudin-Sutter, Sarah Sutter, Raoul BMC Infect Dis Research Article BACKGROUND: Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. METHODS: Consecutive patients with meningitis and/or encephalitis form 2011–17 at a Swiss academic medical care center were included in this cross-sectional study. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. Infectious meningitis and/or encephalitis were defined as the composite outcome. For diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Multinomial logistic regression was performed to identify predictors of the composite outcome. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. An AUROC between 0.7–0.8 was defined as “good”, 08–0.9 as “excellent”, and > 0.9 as “outstanding”. Calibration was defined as “good” if the goodness of fit tests revealed insignificant p-values. RESULTS: Among 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Most frequent infectious pathogens were Streptococcus pneumoniae, Varicella zoster, and Herpes simplex 1&2. While in multivariable analysis lactate concentrations and decreased glucose ratios were the only independent predictors of bacterial infection (AUROCs 0.780, 0.870, and 0.834 respectively), increased CSF mononuclear cells were the only predictors of viral infections (AUROC 0.669). All predictors revealed good calibration. CONCLUSIONS: Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. While increased CSF lactate and decreased glucose ratio are is the most reliable predictors of bacterial infections in patients with meningitis and/or encephalitis, only mononuclear cell counts predicted viral infections. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03856528. Registered on February 26th 2019. BioMed Central 2020-04-23 /pmc/articles/PMC7181581/ /pubmed/32326881 http://dx.doi.org/10.1186/s12879-020-05022-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Dittrich, Tolga Marsch, Stephan Egli, Adrian Rüegg, Stephan De Marchis, Gian Marco Tschudin-Sutter, Sarah Sutter, Raoul Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title | Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title_full | Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title_fullStr | Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title_full_unstemmed | Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title_short | Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
title_sort | predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181581/ https://www.ncbi.nlm.nih.gov/pubmed/32326881 http://dx.doi.org/10.1186/s12879-020-05022-6 |
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