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

Lise E. Nigrovic, Richard Malley, Charles G. Macias, John T. Kanegaye, Donna M. Moro-Sutherland, Robert D. Schremmer, Sandra H. Schwab, Dewesh Agrawal, Karim M. Mansour, Jonathan E. Bennett, Yiannis L. Katsogridakis, Michael M. Mohseni, Blake Bulloch, Dale W. Steele, Ron L. Kaplan, Martin I. Herman, Subhankar Bandyopadhyay, Peter Dayan, Uyen T. Truong, Vince J. WangBema K. Bonsu, Jennifer L. Chapman, Nathan Kuppermann

Research output: Contribution to journalArticle

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Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)726-730
Number of pages5
JournalPediatrics
Volume122
Issue number4
DOIs
StatePublished - Oct 2008

Fingerprint

Bacterial Meningitides
Cerebrospinal Fluid
Anti-Bacterial Agents
Cerebrospinal Fluid Proteins
Spinal Puncture
Leukocyte Count
Glucose
Neutrophils
Leukocytosis
Agglutination
Latex
Medical Records
Hospital Emergency Service

Keywords

  • Antibiotic pretreatment
  • Bacterial meningitis
  • Cerebrospinal fluid
  • Children

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Nigrovic, L. E., Malley, R., Macias, C. G., Kanegaye, J. T., Moro-Sutherland, D. M., Schremmer, R. D., ... Kuppermann, N. (2008). Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics, 122(4), 726-730. https://doi.org/10.1542/peds.2007-3275

Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. / Nigrovic, Lise E.; Malley, Richard; Macias, Charles G.; Kanegaye, John T.; Moro-Sutherland, Donna M.; Schremmer, Robert D.; Schwab, Sandra H.; Agrawal, Dewesh; Mansour, Karim M.; Bennett, Jonathan E.; Katsogridakis, Yiannis L.; Mohseni, Michael M.; Bulloch, Blake; Steele, Dale W.; Kaplan, Ron L.; Herman, Martin I.; Bandyopadhyay, Subhankar; Dayan, Peter; Truong, Uyen T.; Wang, Vince J.; Bonsu, Bema K.; Chapman, Jennifer L.; Kuppermann, Nathan.

In: Pediatrics, Vol. 122, No. 4, 10.2008, p. 726-730.

Research output: Contribution to journalArticle

Nigrovic, LE, Malley, R, Macias, CG, Kanegaye, JT, Moro-Sutherland, DM, Schremmer, RD, Schwab, SH, Agrawal, D, Mansour, KM, Bennett, JE, Katsogridakis, YL, Mohseni, MM, Bulloch, B, Steele, DW, Kaplan, RL, Herman, MI, Bandyopadhyay, S, Dayan, P, Truong, UT, Wang, VJ, Bonsu, BK, Chapman, JL & Kuppermann, N 2008, 'Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis', Pediatrics, vol. 122, no. 4, pp. 726-730. https://doi.org/10.1542/peds.2007-3275
Nigrovic LE, Malley R, Macias CG, Kanegaye JT, Moro-Sutherland DM, Schremmer RD et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics. 2008 Oct;122(4):726-730. https://doi.org/10.1542/peds.2007-3275
Nigrovic, Lise E. ; Malley, Richard ; Macias, Charles G. ; Kanegaye, John T. ; Moro-Sutherland, Donna M. ; Schremmer, Robert D. ; Schwab, Sandra H. ; Agrawal, Dewesh ; Mansour, Karim M. ; Bennett, Jonathan E. ; Katsogridakis, Yiannis L. ; Mohseni, Michael M. ; Bulloch, Blake ; Steele, Dale W. ; Kaplan, Ron L. ; Herman, Martin I. ; Bandyopadhyay, Subhankar ; Dayan, Peter ; Truong, Uyen T. ; Wang, Vince J. ; Bonsu, Bema K. ; Chapman, Jennifer L. ; Kuppermann, Nathan. / Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. In: Pediatrics. 2008 ; Vol. 122, No. 4. pp. 726-730.
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abstract = "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 ≥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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T1 - Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis

AU - Nigrovic, Lise E.

AU - Malley, Richard

AU - Macias, Charles G.

AU - Kanegaye, John T.

AU - Moro-Sutherland, Donna M.

AU - Schremmer, Robert D.

AU - Schwab, Sandra H.

AU - Agrawal, Dewesh

AU - Mansour, Karim M.

AU - Bennett, Jonathan E.

AU - Katsogridakis, Yiannis L.

AU - Mohseni, Michael M.

AU - Bulloch, Blake

AU - Steele, Dale W.

AU - Kaplan, Ron L.

AU - Herman, Martin I.

AU - Bandyopadhyay, Subhankar

AU - Dayan, Peter

AU - Truong, Uyen T.

AU - Wang, Vince J.

AU - Bonsu, Bema K.

AU - Chapman, Jennifer L.

AU - Kuppermann, Nathan

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N2 - 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 ≥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.

AB - 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 ≥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.

KW - Antibiotic pretreatment

KW - Bacterial meningitis

KW - Cerebrospinal fluid

KW - Children

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