Twenty-four Hour After-Treatment Lumbar Puncture: Should It Be Done?

Abstract

Drs Lebel and McCracken recently reported that delayed sterilization of the cerebrospinal fluid (CSF) during treatment of bacterial meningitis in infants and children was significantly associated with a complicated course (seizures, subdural effusions, and hemiparesis) and a higher incidence of neurologic sequelae. They suggested that a repeat CSF culture after approximately 24 hours of therapy should be done in selected cases for documentation of bacteriologic cure and prediction of prognosis. The authors' data also clearly indicated that (1) the younger age of the patient, (2) seizure before admission, and (3) lower glucose levels in the initial CSF specimen predicted delay in CSF sterilization (tables 3 and 4). It would have been interesting to look at these three parameters further and correlate them with hospital course and long-term sequelae, to determine whether they would be just as good as a repeat CSF examination in predictng outcome.