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CSF lactate for accurate diagnosis of community-acquired bacterial meningitis

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Abstract

CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74 %) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm3), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100 % sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.

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Acknowledgments

We thank Prof. Jean-Daniel Baumgartner, Morges, Switzerland and Dr. Laurent Christin, Nyon, Switzerland for their participation in the acute meningitis cohort study.

We thank Drs. Daniel Bardy and Olivier Boulat, Laboratory of Clinical Chemistry, Department of Laboratories, Lausanne University Hospital (CHUV), for providing technical information on the studied CSF parameters.

Study funding

The study was partially supported by unrestricted research grants from the Quality Control Program of the Lausanne University Hospital (Project # 127) and the Foundation for the Advancement in Medical Microbiology and Infectious Diseases (FAMMID), Lausanne, Switzerland.

Conflict of interest

The authors declare no competing financial interest in relation to the manuscript.

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Author notes

    Authors and Affiliations

    1. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

      S. Giulieri, C. Chapuis-Taillard, J. Bille, P. Meylan, O. Manuel & O. Marchetti

    2. Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland

      K. Jaton, J. Bille & P. Meylan

    3. Internal Medicine Service, Regional Hospital, Yverdon, Switzerland

      A. Cometta

    4. Internal Medicine Service, Cantonal Hospital, Fribourg, Switzerland

      C. Chuard

    5. Emergency Medicine Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland

      O. Hugli

    6. Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland

      R. Du Pasquier

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    1. S. Giulieri
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    2. C. Chapuis-Taillard
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    Correspondence to S. Giulieri.

    Additional information

    This study received the ICAAC Program Committee Award in Clinical Microbiology and Diagnosis at the 52nd ICAAC, San Francisco, CA, USA, September 9–12, 2012 (Oral presentation 1321 - # L1-1221, session “New Insights in Bacterial Meningitis”) and was presented at the Annual Meeting of the Swiss Societies for Infectious Diseases, Hospital Hygiene, and Travel Medicine, Lugano, May 30, 2013 (Oral presentation).

    O. Manuel and O. Marchetti contributed equally to this work.

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    Giulieri, S., Chapuis-Taillard, C., Jaton, K. et al. CSF lactate for accurate diagnosis of community-acquired bacterial meningitis. Eur J Clin Microbiol Infect Dis 34, 2049–2055 (2015). https://doi.org/10.1007/s10096-015-2450-6

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    • DOI: https://doi.org/10.1007/s10096-015-2450-6

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