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Cerebrospinal fluid analysis insufficient to rule out meningitis in older infants
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Cerebrospinal fluid analysis should be used to rule out bacterial meningitis in infants aged 21 days and younger or are not well-appearing, according to study findings.
Elena Martinez, MD, of the pediatric ED at Cruces University Hospital in Spain, and colleagues additionally recommend the reevaluation of utilizing laboratory tests alone for the systematic performance of lumbar punctures in well-appearing infants aged older than 21 days.
“Classical criteria differ when performing cerebrospinal fluid analysis in infants younger than 90 days with fever without a source,” Martinez and colleagues wrote. “Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors.”
The substudy included data from a prospective registry of 2,362 infants aged younger than 90 days with fever without a source treated in the pediatric ED of a tertiary teaching hospital between September 2003 and August 2013. The researchers defined well-appearing infants as those with normal findings, based on the pediatric assessment triangle of “appearance, work of breathing and circulation to skin.”
Twenty-seven percent of the cohort underwent lumbar puncture, with infants classified as not well-appearing (OR = 4.49; 95% CI, 2.83-7.15) and those aged 21 days or younger (OR = 9.14; 95% CI, 6.95-12.02) representing the majority (60.9% vs. 25.7% among well-appearing infants).
Of the 11 infants diagnosed with bacterial meningitis, nine were aged 21 days or younger (OR = 30.42; 95% CI, 6.13-204.6) and five were not well-appearing (OR = 23.06; 95% CI, 5.97-87.44). Isolated bacteria types included: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, S. pneumoniae and Neisseria meningitidis.
Bacterial meningitis was not diagnosed in any of the 1,975 well-appearing infants aged older than 21 days, according to the researchers. There were no deaths; one case of motor developmental delay was diagnosed in a patient with meningitis associated with E. coli.
“In light of our results, the systematic analysis of cerebrospinal fluid on the basis of blood test results alone does not seem appropriate beyond the neonatal period in well-appearing infants younger than 90 days with [fever without a source],” the researchers concluded. – by Jennifer Southall
Disclosure: The researchers report no relevant financial disclosures.
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