Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis

Nigrovic, L. E.; Malley, R.; Macias, C. G.; Kanegaye, J. T.; Moro-Sutherland, D. M.; Schremmer, R. D.; Schwab, S. H.; Agrawal, D.; Mansour, K. M.; Bennett, J. E.; Katsogridakis, Y. L.; Mohseni, M. M.; Bulloch, B.; Steele, D. W.; Kaplan, R. L.; Herman, M. I.; Bandyopadhyay, S.; Dayan, P.; Truong, U. T.; Wang, V. J.; Bonsu, B. K.; Chapman, J. L.; Kuppermann, N.; American Academy of Pediatrics, Pediatric Emergency Medicine Collaborative Research Committee

Pediatrics. 2008 Oct 3; 122(4):726-30


OBJECTIVE: The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis. METHODS: We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture. RESULTS: We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with >or=12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for <12 hours, had significantly higher median cerebrospinal fluid glucose levels (48 mg/dL vs 29 mg/dL) and lower median cerebrospinal fluid protein levels (121 vs 178 mg/dL). CONCLUSIONS: In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

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