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
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.
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.
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.
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.
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.
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.
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.