Predictors of bacterial meningitis in the era after Haemophilus influenzae
Predictors of bacterial meningitis in the era after Haemophilus influenzae
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DOI：
10.1001/archpedi.155.12.1301
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发表时间：
2001-12-01
影响因子：
--
通讯作者：
Dick, PT
中科院分区：
文献类型：
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作者：
Freedman, SB;Marrocco, A;Dick, PT
目的：为了确定在B型流感嗜血杆菌之后的时代，脑脊液（CSF）白色血细胞（WBC）计数是否可以安全地用于将怀疑患有细菌性脑膜炎的儿童分为低风险组和高风险组。设计：CSF样本的回顾性分析。设置：多伦多安大略三级护理儿科中心，1992年1月1日至1996年10月1日。患者：包括从2个月至17岁儿童中采集的所有CSF样本。最终的数据库包括1617无创伤样本的儿童没有以前的神经或免疫疾病谁进行了腰椎穿刺，以评估社区获得性细菌性脑膜炎的可能性。主要结果措施：CSF白细胞计数，分类，蛋白质和葡萄糖的预测值。5例每微升CSF WBC为3或更少，6例每微升CSF WBC为4至30。白细胞数≤ 30/μ L的脑脊液标本对细菌性脑膜炎的阴性预测值为99.3%。每微升WBC数大于30的脑脊液样本细菌性脑膜炎的似然比为10.3（95%置信区间，8.0-13.1），阳性预测值为22.3%。细菌性脑膜炎的其他显着的预测因素包括年龄，脑脊液葡萄糖，蛋白质，革兰氏染色，脑脊液-血清葡萄糖比率，和外周血带count.Conclusions：考虑到细菌性脑膜炎的发生在儿童的情况下，脑脊液白细胞增多症，其他因素应考虑在管理儿童疑似细菌性脑膜炎。6个月以上的儿童，脑脊液白细胞数为30/微升或更少，细菌性脑膜炎的风险较低。如果临床稳定且无细菌性脑膜炎的其他实验室标志物，则住院和经验性抗生素治疗可能是不必要的。
Objective: To determine if, in the era after Haemophilus influenzae type b, the cerebrospinal fluid (CSF) white blood cell (WBC) count can be safely used to stratify children suspected of having bacterial meningitis into low-and high-risk groups.Design: Retrospective analysis of CSF samples.Setting: Tertiary care pediatric center in Toronto Ontario, between January 1, 1992, and October 1, 1996.Patients: All CSF samples collected on children aged 2 months to 17 years were included. The final database consisted of 1617 atraumatic samples from children without prior neurologic or immunologic disease who underwent a lumbar puncture to assess the possibility of community-acquired bacterial meningitis.Main Outcome Measures: The predictive values of CSF WBC count, differential, protein, and glucose.Results: There were 44 cases of bacterial meningitis. Five had 3 CSF WBCs per microliter or less, and 6 had 4 to 30 CSF WBCs per microliter. The negative predictive value of CSF specimens with 30 WBCs per microliter or less for bacterial meningitis was 99.3%. Cerebrospinal fluid samples with greater than 30 WBCs per microliter had a likelihood ratio for bacterial meningitis of 10.3 (95% confidence interval, 8.0-13.1) and a positive predictive value of 22.3%. Other significant predictors of bacterial meningitis included age, CSF glucose, protein, gram stain, CSF-serum glucose ratio, and peripheral blood band count.Conclusions: Given the occurrence of bacterial meningitis in children in the absence of CSF pleocytosis, other factors should be considered when managing children with suspected bacterial meningitis. Children older than 6 months with 30 CSF WBCs per microliter or less are at low risk for bacterial meningitis. If clinically stable and without other laboratory markers of bacterial meningitis, hospital admission and empiric antibiotic therapy may be unwarranted.