Cerebrospinal Fluid Cultures in Term Infants

Abstract

Research Article| August 01 2017 Cerebrospinal Fluid Cultures in Term Infants AAP Grand Rounds (2017) 38 (2): 20. https://doi.org/10.1542/gr.38-2-20 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Cerebrospinal Fluid Cultures in Term Infants. AAP Grand Rounds August 2017; 38 (2): 20. https://doi.org/10.1542/gr.38-2-20 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebrospinal fluid culture Source: Leazer R, Erickson N, Paulson J, et al. Epidemiology of cerebrospinal fluid cultures and time to detection in term infants. Pediatrics. 2017; 139(5): e20163268Google Scholar Researchers from multiple institutions conducted a retrospective chart review to determine the time to detection (TTD) for positive cerebrospinal fluid (CSF) culture results and to provide an update on the current epidemiology of bacterial meningitis in term infants. To identify positive culture results and their TTD, researchers used the electronic microbiology database at 4 participating hospitals (Children’s Hospital of The King’s Daughters, Children’s Hospital Los Angeles, Children’s Hospital and Clinics of Minnesota, and Santa Clara Valley Medical Center). Positive CSF culture results were included if they were obtained in infants £90 days of age in an emergency department or inpatient setting between January 2000 and December 2013. Culture specimens were excluded if they were obtained from a ventricular shunt, intraoperatively, in preterm infants, or in infants with major medical conditions. The charts of patients with positive culture results were reviewed to classify the positive culture as a true-positive result (ie, due to a pathogen) or a contaminant. Classifications were based on the attending physician’s treatment plan or on bacteria typically considered to be nonpathogenic (eg, coagulase-negative Staphylococcus and diphtheroids). TTD was compared between true-positive results and contaminants. A total of 410 positive CSF culture results were identified. Of these, 53 (12.9%) were true-positive results. The most common pathogens were group B Streptococcus (51%), Escherichia coli (13%), and Streptococcus pneumoniae (9%). True-positive results had a mean TTD of 28.6 hours (95% confidence interval [CI], 24.0–33.2), with 81% positive within 36 hours. Contaminants had a mean TTD of 68.1 hours (95% CI, 64.3–71.9). There were significantly more true-positive results than contaminants that were positive within 36 hours (P < .001). The researchers conclude that most pathogenic bacteria in CSF exhibit growth within 36 hours, and group B Streptococcus remains the most common isolate. Dr Mintzer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Prompt diagnosis of bacterial meningitis is critical for optimization of management strategies, including antibiotic selection, dose, and duration; need for further diagnostic studies; and prognostication. The difficulty in establishing a diagnosis of bacterial meningitis confounds this clinical scenario for numerous reasons: vague clinical history, nonspecific physical examination findings, difficulty obtaining CSF, traumatic lumbar puncture procedures, and low CSF culture positivity rates.1 In addition, as shown in the current study, contamination of CSF samples can further hamper diagnostic efforts. In this retrospective multicenter study of 410 positive CSF culture findings, the researchers classified most CSF isolates as contaminants, leaving only 12.9% as true-positive results requiring clinical management consideration. As previously reported, group B Streptococcus remains the predominant pathogen detected in CSF cultures in febrile infants.2,3 In addition, similar to blood and urine culture findings,4,5 a more rapid TTD was... You do not currently have access to this content.