Abstract

SONO, L; WADULA, J  and  VELAPHI, S. Cerebrospinal fluid indices and culture concordance with blood in neonates with culture-proven meningitis. S. Afr. j. child health [online]. 2024, vol.18, n.1, pp.63-67. ISSN 1999-7671.  http://dx.doi.org/10.7196/SAJCH.2024.v18i1.1103.

BACKGROUND. Diagnosing meningitis in sick neonates is challenging because they are often unstable for lumbar puncture (LP). In this scenario, antibiotic selections are based on positive blood culture (BC), assuming concordance between blood and cerebrospinal fluid (CSF) cultures. The value of CSF cultures is diminished when LP is performed after initiating antibiotics. Therefore, CSF white cell count (CSF-WCC) and chemistry serve as proxies for diagnosing meningitis. OBJECTIVE. To assess concordance between blood and CSF cultures and identify differences in CSF-WCC and protein levels between positive and negative CSF cultures. METHODS. We enrolled neonates who had both CSF and BCs taken for sepsis workup. Comparisons between blood and CSF cultures were performed to assess concordance. CSF-WCC and protein level discrepancies were compared between positive and negative CSF cultures. RESULTS. Ultimately, 448 neonates over 12 months met the criteria. Among those with positive BC results, 16.7% had positive CSF cultures, whereas for those with culture-positive CSF, 59.2% had positive BC. The concordance of organisms was 82.8% among those with positive blood and CSF cultures. Among neonates with culture-positive CSF, 24.5% and 59.3% had abnormal CSF-WCC and protein levels, respectively. Neonates with a positive CSF culture, compared with a negative culture, had higher CSF-WCC (24.5% v. 10.4%; p<0.001) and protein levels (59.3% v. 37.5%; p<0.001). CONCLUSION. High proportion of neonates with positive CSF cultures had negative BCs. Therefore, meningitis cannot be excluded based on negative BC without LP, for normal CSF-WCC and protein levels without CSF culture results do not exclude meningitis.

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