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Cited by 116Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingInfectious Diseases and Tuberculosis

Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults

Michael, B., Menezes, B. F., Cunniffe, J., Miller, A., Kneen, R., Francis, G., Beeching, N. J., Solomon, T.·2010·Emergency Medicine Journal
DOI 10.1136/emj.2009.075598
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Abstract

INTRODUCTION: Bacterial meningitis is a medical emergency, the outcome of which is improved by prompt antibiotic treatment. For patients with suspected meningitis and no features of severe disease, the British Infection Society recommends immediate lumbar puncture (LP) before antibiotics, to maximise the chance of a positive cerebrospinal (CSF) culture. In such patients, CT scanning before LP is not needed. METHODS: The case notes of adults with meningitis admitted to a large district general hospital over 3 years were reviewed. Patients were classified as Likely Bacterial Meningitis or Likely Viral Meningitis based on their CSF and peripheral blood results using the Meningitest Criteria, with microbiological and virological confirmation. RESULTS: Of 92 patients studied, 24 had Likely Bacterial Meningitis, including 16 with microbiologically confirmed disease (none had PCR tests for bacteria). Sixty-eight had Likely Viral Meningitis, four of whom had viral PCR, including one with herpes simplex virus. No patient had an LP before antibiotics. CSF culture was positive for eight (73%) of the 11 patients who had an LP up to 4 h after starting antibiotics, compared with eight (11%) of 71 patients with a later LP (p<0.001). None of the 34 LPs performed more than 8 h after antibiotics was culture-positive. For 62 (67%) of the 92 patients, the delay was due to a CT scan, although only 20 of these patients had a contraindication to an immediate LP. CONCLUSIONS: Too many patients with acute bacterial meningitis are being sent for unnecessary CT scans, causing delays in the LP, and reducing the chances of a positive CSF culture after starting antibiotics. However, even if antibiotics have been started, an LP within 4 h is still likely to be positive. Molecular tests for diagnosis should also be requested.

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  • CSF culture is the gold standard for diagnosis of bacterial meningitis, but its sensitivity varies between 50% and 90% depending on bacterium type and bacterial load, and decreases when antibiotic treatment has been started prior to CSF collection.

    “While CSF culture is the gold standard for the diagnosis of bacterial meningitis, its sensitivity varies between 50% and 90%, dependent on bacterium type and bacterial load, and decreases when antibiotic treatment has been started prior to the CSF collection (12–14).”

    From Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections (2024) · cites this paper as [14]

  • Benefits of OPAT include reduced costs, shorter inpatient stays, fewer nosocomial infections and increased patient satisfaction.

    “Benefits include reduced costs, shorter inpatient stays, fewer nosocomial infections and increased patient satisfaction.58”

    From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [58]

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Authors
Michael, B., Menezes, B. F., Cunniffe, J., Miller, A., Kneen, R., Francis, G., Beeching, N. J., & Solomon, T.
Affiliations
  • University of Liverpool (GB)
  • Walton Centre (GB)
  • Arrowe Park Hospital (GB)
  • Royal Liverpool University Hospital (GB)
  • Alder Hey Children's NHS Foundation Trust (GB)
ORCID
Venue
Emergency Medicine Journal
Publisher
BMJ
Published
2010-04-01
Volume
27
Issue
6
Pages
433-438
ISSN
  • 1351-0622 (ISSN-L)
  • 1472-0205
  • 1472-0213
DOI
10.1136/emj.2009.075598
OpenAlex
W2102838993
Cited by
116
References
32
Citations by year
2026: 8 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 6 · 2021: 8 · 2020: 10 · 2019: 10 · 2018: 11 · 2017: 4 · 2016: 10 · 2015: 6 · 2014: 4 · 2013: 4 · 2012: 7
FWCI
4.11
Type
journal article
Language
en
Open access
closed
Locations
  • Emergency Medicine Journal (publishedVersion)
  • PubMed (publishedVersion)
  • LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
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
acute bacterial meningitis, lumbar puncture timing, cerebrospinal fluid culture, viral meningitis, herpes simplex virus, delayed diagnosis, adults
MeSH terms
Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Cerebrospinal Fluid, Female, Humans, Male, Meningitis, Viral, Middle Aged, Spinal Puncture, Meningitis, Bacterial, Young Adult, Delayed Diagnosis

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