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Cited by 246Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingInfectious Diseases and Tuberculosis

Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: A meta-analysis

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Sakushima, Ken, Hayashino, Yasuaki, Kawaguchi, Takehiko, Jackson, Jeffrey L., Fukuhara, Shunichi·2011·Journal of Infection
DOI 10.1016/j.jinf.2011.02.010
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Abstract

Objectives Cerebrospinal fluid (CSF) lactate is produced by bacterial anaerobic metabolism and is not affected by blood lactate concentration, an advantage over CSF glucose in differentiating bacterial meningitis from aseptic meningitis. However, the previous investigations have shown mixed results of the sensitivity and specificity. Our study's purpose was to assess the utility of CSF lactate in differentiating bacterial meningitis from aseptic meningitis.Methods We searched MEDLINE and EMBASE for clinical studies that included CSF lactate measurement in bacterial meningitis and aseptic meningitis. Test characteristics were pooled using hierarchical summary ROC curve and random effects model.Results Thirty three studies were included. The pooled test characteristics of CSF lactate were sensitivity 0.93 (95% CI: 0.89-0.96), specificity 0.96 (95% CI: 0.93-0.98), likelihood ratio positive 22.9 (95% CI: 12.6-41.9), likelihood ratio negative 0.07 (95% CI: 0.05-0.12), and diagnostic odds ratio 313 (95% CI: 141-698). Pretreatment with antibiotics lowered the sensitivity 0.49 (95% CI: 0.23-0.75). CSF lactate of around 35 mg/dl (34-36 mg/dl) had higher sensitivity and specificity than those of around 27 mg/dl (26-28 mg/dl).Conclusions CSF lactate's high negative likelihood ratio may make it useful for ruling out bacterial meningitis though pretreatment with antibiotics reduces clinical accuracy. CSF lactate of 35 mg/dl could be optimal cut-off value for distinguishing bacterial meningitis from aseptic meningitis.

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  • CSF lactate provides an independent and strong discriminator: values above 6.6 mmol/L indicate a high probability of bacterial infection and warrant continuation or adaptation of empiric antibiotics, whereas values below 3.2 mmol/L support early antibiotic discontinuation when FAME is negative.

    “CSF lactate provides an independent and strong discriminator: values above 6.6 mmol/L indicate a high probability of bacterial infection and warrant continuation or adaptation of empiric antibiotics, whereas values below 3.2 mmol/L support early antibiotic discontinuation when FAME is negative (30, 31).”

    From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [31]

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Authors
Sakushima, K., Hayashino, Y., Kawaguchi, T., Jackson, J. L., & Fukuhara, S.
Affiliations
  • Hokkaido University (JP)
  • Kyoto University (JP)
  • Japanese Red Cross Nagoya Daini Hospital (JP)
  • Walter Reed National Military Medical Center (US)
Corresponding author
Sakushima, Ken
ORCID
Venue
Journal of Infection
Publisher
Elsevier BV
Published
2011-04
Volume
62
Issue
4
Pages
255-262
ISSN
0163-4453 (ISSN-L)
DOI
10.1016/j.jinf.2011.02.010
OpenAlex
W1995162670
Cited by
246
References
62
Citations by year
2026: 12 · 2025: 11 · 2024: 14 · 2023: 13 · 2022: 16 · 2021: 18 · 2020: 19 · 2019: 21 · 2018: 25 · 2017: 14 · 2016: 23 · 2015: 16 · 2014: 13 · 2013: 15 · 2012: 11
FWCI
1.59
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Infection (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Repositories DataBase (IRDB) (submittedVersion)
  • Hokkaido University Collection of Scholarly and Academic Papers (Hokkaido University) (submittedVersion)
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords
cerebrospinal fluid lactate, bacterial meningitis, aseptic meningitis, diagnostic accuracy, sensitivity and specificity, likelihood ratios, diagnostic thresholds, antibiotic pretreatment, CSF glucose
MeSH terms
Diagnosis, Differential, Humans, Meningitis, Aseptic, Predictive Value of Tests, Sensitivity and Specificity, Reproducibility of Results, Meningitis, Bacterial, Lactic Acid

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