![]() In addition, most studies are restricted to small sample sizes and to the era in which non-culture based diagnostic tests, such as serology and polymerase chain reaction (PCR) were not readily available. Although microbiologic and CSF analyses are strongly recommended in patients with suspected infectious meningitis and/or encephalitis by international guidelines including the Neurocritical Care Society (NCS), evidence from large cohort studies in adults regarding the diagnostic yield of CSF analysis is limited to a small number of studies with various study designs, cohort definitions, and study quality. Most importantly, they maintain that the presence of these infections cannot be proven without examination of the cerebrospinal fluid (CSF). Despite these efforts, the ESCMID, the European Study Group for Infections of the Brain ESGIB, and the Consensus Statement of the IEC concluded that none of the published diagnostic algorithms were reliable to identify patients with infectious meningitis and/or encephalitis in adult patients upon validation in independent cohorts. The high morbidity and mortality of infectious meningitis, encephalitis, and meningoencephalitis and the low specificity of their clinical signs and symptoms have led to a number of studies aiming to generate prediction models for the presence of infectious meningitis and/or encephalitis as summarized by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the Consensus Statement of the International Encephalitis Consortium (IEC). Trial registrationĬ identifier NCT03856528. 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. Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. All predictors revealed good calibration. 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). Most frequent infectious pathogens were Streptococcus pneumoniae, Varicella zoster, and Herpes simplex 1&2. ResultsĪmong 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Calibration was defined as “good” if the goodness of fit tests revealed insignificant p-values. ![]() An AUROC between 0.7–0.8 was defined as “good”, 08–0.9 as “excellent”, and > 0.9 as “outstanding”. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. Multinomial logistic regression was performed to identify predictors of the composite outcome. Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious meningitis and/or encephalitis were defined as the composite outcome.įor diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. MethodsĬonsecutive patients with meningitis and/or encephalitis form 2011–17 at a Swiss academic medical care center were included in this cross-sectional study. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low.
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