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Bacterial meningitis score inadequate in infants aged 0 to 60 days
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A recent study found that the bacterial meningitis score had high sensitivity but poor specificity when identifying bacterial meningitis in infants aged 0 to 60 days.
“The bacterial meningitis score is a widely validated clinical prediction rule for identifying children with [cerebrospinal fluid (CSF)] pleocytosis who are very low risk for bacterial meningitis,” Chris A. Rees, MD, MPH, clinical fellow in pediatric emergency medicine at Boston Children’s Hospital, told Infectious Diseases in Children. “However, based on the results of our study of 4,292 infants 60 days of age or younger with CSF pleocytosis, the specificity of the bacterial meningitis score was too low for this clinical prediction rule to be applied clinically in this age group.”
Rees and colleagues conducted a secondary analysis of a recent multicenter retrospective study of infants aged 60 days or younger who had CSF culture testing for herpes simplex virus performed in one of 23 North American EDs. The sub-study was limited to infants who were evaluated at one of 21 participating centers that contributed infant CFS cell counts. Infants aged 0 to 60 days who were evaluated in an ED and had CSF pleocytosis were included in the study. They were considered “not low risk” if they had any high-risk laboratory predictors, and those without those predictors were classified as “very low risk” for bacterial meningitis.
A total of 4,479 infants with CSF pleocytosis were evaluated for the study. Of these infants, 121 (2.7%; 95% CI, 2.3%-3.2%) had bacterial meningitis. The most common pathogen among the infected infants was group B Streptococcus species (n = 57 [47.1%]), followed by Escherichia coli (n = 19 [15.7%]). Researchers were able to apply laboratory predictors of the bacterial meningitis score to 95.8% of infants in the study.
Although the bacterial meningitis score accurately identified the 121 eligible infants with bacterial meningitis (sensitivity, 100.0%; 95% CI, 96.5%-100%), it classified only 66 infants as very low risk (specificity, 1.6%; 95% CI, 1.3%-2%) in both the 0-to-28-day age group and 29-to-60-day age group.
Researchers suggested that clinicians should not apply the bacterial meningitis score to risk stratify infants aged 0 to 60 days with CSF pleocytosis, and recommended optimizing the diagnostic approach of these infants through novel clinical prediction rules and diagnostic biomarkers. – by Erin Michael
Disclosure: Rees reports no relevant financial disclosures.
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