Saha A, Kanamgode SS, Malempati SC, Chaudhuri S, Scott J. Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis. World J Neurol 2023; 9(4): 37-43 [DOI: 10.5316/wjn.v9.i4.37]
Corresponding Author of This Article
Arunava Saha, MD, Department of Internal Medicine, Saint Vincent Hospital, 123, Summer Street, Worcester, MA 01608, United States. saha.arunava100@gmail.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Arunava Saha, Shihla Shireen Kanamgode, Sarat Chandra Malempati, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Sirshendu Chaudhuri, Assistant Professor, Indian Institute of Public Health, Hyderabad 500030, Telangana, India
Jeffrey Scott, Department of Pulmonary and Critical Care Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Author contributions: Saha A, Kanamgode SS and Scott J were involved in the conception of idea and study design; Chaudhuri S and Scott J provided administrative support; Scott J helped in provision of study materials or patients; Saha A, Kanamgode SS and Malempati SC were involved in collection and assembly of data; Saha A, Chaudhuri S and Scott J were involved in data analysis and interpretation; All authors were involved in manuscript writing; and the final draft was approved by all authors.
Institutional review board statement: The study-protocol was approved by the Ethics Committee of Metrowest Medical Center, IRB#2023-005.
Informed consent statement: Informed consent was waived as it was a retrospective chart review.
Conflict-of-interest statement: The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at saha.arunava100@gmail.com. It was a retrospective study, hence consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arunava Saha, MD, Department of Internal Medicine, Saint Vincent Hospital, 123, Summer Street, Worcester, MA 01608, United States. saha.arunava100@gmail.com
Received: May 20, 2023 Peer-review started: May 20, 2023 First decision: June 15, 2023 Revised: June 26, 2023 Accepted: July 7, 2023 Article in press: July 7, 2023 Published online: July 31, 2023 Processing time: 72 Days and 2.4 Hours
ARTICLE HIGHLIGHTS
Research background
The classic triad of headache, fever and neck stiffness is not always present in acute meningitis syndrome; however, diagnosis with lumbar puncture and immediate empirical antibiotic coverage remains cornerstone of therapy. In some cases, cerebrospinal fluid (CSF) analysis is also not available, leading to long term empiric antibiotics use or potential undertreatment.
Research motivation
We aimed to investigate the correlation between lumbar puncture in patients with suspected acute bacterial meningitis and their overall outcome, and determine if empirical therapy was beneficial.
Research objectives
To determine the percent of patients presenting with acute meningitis syndrome who underwent a successful diagnostic procedure, the reasons why some patients did not, and the impact a successful procedure had on patient treatment in terms of duration of antibiotic therapy and overall outcomes.
Research methods
We conducted a retrospective study among patients presenting with acute meningitis syndrome to a 360-bed community hospital in central Massachusetts. The patients were divided into two groups based on whether they received a lumbar puncture to confirm the diagnosis of acute bacterial meningitis. Data was collected and analyzed with respect to duration of antibiotic use and overall outcome.
Research results
A total of 169 patients admitted with acute meningitis syndrome were included. Lumbar puncture (LP) was performed for 130 (76.9%) participants, out of which, 28 (21.5%) showed some growth in CSF culture. Amongst the 39 patients in whom LP was deferred, 21 had no reason documented, 6 had increased body mass index (n = 6, 15.4%), and 4 had unsuccessful attempts. While 93 (71.5%) patients with LP received antibiotic therapy, only 19 (48.7%) patients without LP received the antibiotics with similar mean duration in both groups. Long term sequalae and death was higher in the non-LP compared to the LP group.
Research conclusions
Deferral of lumbar puncture is associated with poorer outcomes in patients with suspected acute meningitis syndrome. Lack of CSF analysis may be associated with unnecessary antibiotic therapy in some and poor outcomes related to inadequate treatment in others.
Research perspectives
Further prospective studies are needed to determine the exact reasons for deferral of lumbar puncture in patients. This will allow to identify potential caveats and ensure availability of adequate resources to obtain a CSF sample in all patients who need it.
