Elsevier

Clinical Neurology and Neurosurgery

Volume 174, November 2018, Pages 198-202
Clinical Neurology and Neurosurgery

CSF leukocyte, polykaryocyte, protein and glucose: Their cut-offs of judging whether post-neurosurgical bacterial meningitis has been cured

https://doi.org/10.1016/j.clineuro.2018.09.023Get rights and content

Highlights

  • Only CSF leukocyte and polykaryocyte can direct when to stop antibiotics.

  • Their normal reference values are not the standard of cure for PNBM.

  • The reference value of leukocyte is not recommended as 0–10/mm3 but 0–44/mm3.

  • The reference value of polykaryocyte is not recommended as 0–5/mm3 but 0–3/mm3.

Abstract

Object

This paper is aimed to explore a reasonable guideline for distinguishing whether post-neurosurgical bacterial meningitis has completely been cured, so as to avoid the deficient or excessive treatment for post-neurosurgical bacterial meningitis.

Patients and methods

We conducted a retrospective analysis of 46 patients who attended General Hospital of Chinese People’s Armed Police Force in Beijing, China, from January 1, 2014 to April 30, 2016. The CSF leukocyte, polykaryocyte, protein and glucose had been tested when their antibiotic treatments were empirically stopped. Between the non-relapse and relapse groups, Wilcoxon Rank Sum test was used to compare the differences of CSF leukocyte and polykaryocyte, and t-test was applied to contrast the distinctions of CSF protein and glucose, then, the thresholds of significant items were estimated by ROC curve.

Results

The CSF leukocyte counts in non-relapse group are 23.72 ± 14.12/mm3, which are statistically less than the relapse group’s (47.00 ± 1.00/mm3, P = 0.014), so does the CSF polykaryocyte counts (1.74 ± 4.84/mm3 &4.67 ± 1.15/mm3, P = 0.012). Between the two groups, the AUCs of leucocyte and polykaryocyte are 0.926 (95% CI = 0.845–1.0, P = 0.014) and 0.884 (95%CI = 0.786–0.982, P = 0.028), respectively. Their critical values are 44/mm3 (sensitivity = 1, specificity = 0.907) and 3/mm3 (sensitivity = 1, specificity = 0.837). Conversely, CSF protein and glucose have no statistic differences between the two groups.

Conclusion

Both CSF leukocyte and polykaryocyte can satisfactorily indicate whether the post-neurosurgical bacterial meningitis has completely been cured, 0–44/mm3 is recommended as the reference range of CSF leukocyte, and the CSF polykaryocyte’ s is 0–3/mm3.

Introduction

Post-neurosurgical bacterialmeningitis(PNBM) is a lethal complication after neurosurgery [1,2], Erdem's team reported that its fatality rate was approximate 40.8% [3]. CSF leukocyte, polykaryocyte, protein and glucose are generally used to diagnose the PNBM, and their normal reference ranges are subjectively regarded as a guideline to determine whether PNBM has already been cured. However, in clinical practice, it is true that PNBM has not recur among most patients although their CSF leukocyte, polykaryocyte, protein and glucose are still slightly abnormal when anti-infection treatment was stopped. Therefore, it is irrational to regard their normal reference values as an inflexible guideline to decide when to end anti-infection treatment for such patients.

This study is aimed to build a more scientific and reasonable criterion for judging whether PNBM has been cured. Few papers have been engaged in this work, so, it is an innovative goal for this one to explore such a guideline, which will help neurosurgeons to catch the right time to stop antibiotic treatment, so as to avoid the deficient or excessive treatment for PNBM.

Section snippets

Study location and population

The study was conducted at the General Hospital of Chinese People’s Armed Police Force which is a grade iii-A hospital in Beijing. Its Department of Neurotrauma is a major neurosurgery center in Beijing and good at the treatment of PNBM. Department records of 51 patients, who were diagnosed as PNBM and successfully cured from January 1, 2014 to April 30, 2016, were reviewed, five patients were excluded because their data sheets were not complete, and 46 patients were up to inclusion criteria.

Case definition

Results

Among the 46 patients who were up to inclusion criteria, 29 patients were male and 17 were female. Their ages ranged from 17 to 68 years (average = 46.12 ± 14.17 years). Cultures of CSF were carried among this set of patients, the results were positive in 11 (23.9%) cases including 3 cases with the pathogen of gram-positive bacterium and 8 cases with the pathogen of gram-negative bacterium (acinetobacter baumannii in 4 cases). When antibiotic treatments were stopped, all patients’ temperature

Discussion

PNBM often happens from the third day to the seventh day after neurosurgery, with the incidence of 0.3%–8.9% [4]. There is a hallmark event that the Blood-Brain Barrier (BBB) is broken down because of pathogen derived toxins and host over-expressed inflammatory factors [[4], [5], [6], [7]]. BBB is the structure foundation for the central nervous system to maintain its internal environment stable [8]. It can prevent almost all kinds of cells permeating from the blood into subarachnoid space [9,10

Conclusions

When patients’ temperature keeps normal and their meningeal irritation become negative in the final stage of PNBM, both CSF leukocyte and polykaryocyte will be significant helpers for catching the right time to stop anti-infection treatment for PNBM. Although CSF leukocyte counts are still mildly above normal reference range, PNBM has already been cured. On the contrary, PNBM may recurrent although CSF polykaryocyte counts have already been down to its normal reference value. So, it is

Limitation

In this paper, CSF lactate is not routinely available although recent research has indicated usefulness of this parameter in the diagnosis of PNBM and refer to the relevant citations; the same holds true for glucose ratio instead of CSF glucose alone. More patients, up to inclusion criteria, are needed to improve their differential diagnosis accuracy.

Acknowledgments

This research was approved by the ethical committee of General Hospital of Chinese People’s Armed Police Force and supported by the Natural Science Foundation of China. (Fund No. 81171144) We thank patients who participated in this study for answering our following patiently. The authors declare that they have no competing interests.

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