gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

The value of ventricular cerebrospinal fluid for the diagnosis of bacterial meningitis in neurointensive care patients with an already established external ventricular drainage

Klinischer Wert des ventrikulären Liquors in der Diagnose der bakteriellen Meningitis bei neurointensivmedizinischen Patienten mit bereits liegender ventrikulärer Ableitung

Meeting Abstract

  • corresponding author Peter Horn - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • M. Hoffmann - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • T. Bertsch - Institut für Klinische Chemie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • E. Münch - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
  • P. Vajkoczy - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 13.138

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0422.shtml

Published: April 23, 2004

© 2004 Horn et al.
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Outline

Text

Objective

For diagnosis of bacterial meningits, the analysis of lumbar cerebrospinal fluid (CSF) is common practice. In patients with external ventricular drains (EVD) the quick and easy generation of ventricular CSF samples might be an alternative to the lumbar puncture. The purpose of this study was to determine whether ventricular CSF alone or in combination with serum infection markers can identify bacterial meningits as accurately as CSF gained by lumbar puncture.

Methods

Twenty-five patients (13 male, 12 female, age 52.8 ± 16 years) with EVD and suspected postsurgical menignitis were examined. On three consecutive days, lumbar and ventricular CSF samples were taken simultaneously. CSF was sent for Gram´s stain, culture, cytology, total protein, glucose level, and analysis of IL6 and procalcitonin. Blood samples were taken to determine IL6 and procalcitonin. Body temperature and peripheral leukocytosis was evaluated daily. The diagnosis of meningitis was defined by clinical features and CSF findings taken by lumbar puncture (pleocytosis > 0.25x109 per liter, glucose level < 40 mg/dl, protein > 100 mg/dl).

Results

Bacterial meningitis was diagnosed by lumbar CSF samples in 16 patients. Diagnosis of meningitis by cytology of the ventricular CSF revealed a 81% sensitivity and 63% specificity. The correlation between lumbar CSF pleocytosis and ventricular CSF pleocytosis was only a moderate for each examination day. The combination of cytology analysis with IL6 and procalcitonin measurements increased the diagnostic sensivity to 100% with no improvement of diagnostic specifity. Serum procalcitonin levels showed a higher specifity (44%) than serum-IL6 (38%) with a comparable sensitivity (81 vs. 86%). Serum-IL6, serum-procalcitonin and lumbar CSF-IL6 or lumbar CSF-procalcitonin correlated on day one only. No correlations were found on day two or three.

Conclusions

Neither ventricular CSF samples alone nor cytology from ventricular CSF in combination with IL6 and/or procalcitonin are discriminative enough to identify postsurgical meningitis. Lumbar CSF puncture remains the gold standard for the diagnosis of bacterial meningitis.