A set of new guidelines can help predict the risk of bacterial meningitis for children with cerebrospinal fluid pleocytosis, reducing unnecessary hospitalizations and antibiotics, according to a study in the January 3 issue of JAMA.
The majority of children with cerebrospinal fluid (CSF) pleocytosis have viral rather than bacterial meningitis. However, because exclusion of bacterial meningitis requires negative CSF (and blood) cultures, most children with CSF pleocytosis are admitted to the hospital to receive broad-spectrum antibiotics while awaiting culture test results. A highly accurate decision support tool that could identify children with a near-zero risk of bacterial meningitis could assist decision making and limit unnecessary hospital admissions and prolonged antibiotic use.
Lise E. Nigrovic, M.D., M.P.H., of Children’s Hospital Boston and Harvard Medical School, and colleagues conducted a study to validate in a large population a clinical prediction rule, the Bacterial Meningitis Score, which classifies patients at very low risk of bacterial meningitis if they lack 5 criteria. The multicenter study was conducted between January 2001 and June 2004 and included 3,295 children, age 29 days to 19 years with CSF pleocytosis.
Among these patients, 121 (3.7 percent) had bacterial meningitis and 3,174 (96.3 percent) had aseptic (nonbacterial) meningitis. Of the 1,714 patients categorized as very low risk by the Bacterial Meningitis Score, only 2 had bacterial meningitis (both were younger than 2 months old). The sensitivity of the Bacterial Meningitis Score for bacterial meningitis was 98.3 percent and the specificity was 61.5 percent.
The authors recommend admission to the hospital and administration of parenteral antibiotics for patients with at least 1 Bacterial Meningitis Score risk factor or who are younger than 2 months.
Conclusions of the study include that bacterial meningitis has become an uncommon disease in U.S. children. Use of the Bacterial Meningitis Score prediction rule could reduce unnecessary hospital admissions for children with CSF pleocytosis with very low risk of bacterial meningitis.
About the Author
Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.
The author has no financial relationship to any of the companies listed in the article.
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