Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. 726-730 (doi:10.1542/peds.2007-3275)

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ARTICLE

Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children With Bacterial Meningitis

Lise E. Nigrovic, MD, MPH^a, Richard Malley, MD^a, Charles G. Macias, MD, MPH^b, John T. Kanegaye, MD^c, Donna M. Moro-Sutherland, MD^d,e, Robert D. Schremmer, MD^f, Sandra H. Schwab, MD^g, Dewesh Agrawal, MD^h, Karim M. Mansour, MDⁱ, Jonathan E. Bennett, MD^j,k, Yiannis L. Katsogridakis, MD, MPH^l, Michael M. Mohseni, MD^m,n, Blake Bulloch, MD^o, Dale W. Steele, MD^p, Ron L. Kaplan, MD^q, Martin I. Herman, MD^r, Subhankar Bandyopadhyay, MD^s,t, Peter Dayan, MD, MSc^u, Uyen T. Truong, MD^v, Vince J. Wang, MD^w, Bema K. Bonsu, MD^x, Jennifer L. Chapman, MD^x, Nathan Kuppermann, MD, MPH^v for the American Academy of Pediatrics, Pediatric Emergency Medicine Collaborative Research Committee

^a Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
^b Texas Children's Hospital and Baylor College School of Medicine, Houston, Texas
^c Rady Children's Hospital San Diego and University of California, San Diego, School of Medicine, San Diego, California
^d WakeMed Health and Hospitals, Raleigh, North Carolina
^e University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
^f Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
^g Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
^h Children's National Medical Center and George Washington University School of Medicine, Washington, DC
ⁱ Oakland Children's Hospital and Research Center and University of California, Oakland, School of Medicine, Oakland, California
^j A. I. duPont Hospital for Children, Wilmington, Delaware
^k Jefferson Medical College, Philadelphia, Pennsylvania
^l Children's Memorial Hospital and Northwestern Feinberg School of Medicine, Chicago, Illinois
^m Children's Medical Center and Medical College of Georgia, Augusta, Georgia
ⁿ Mayo Clinic Jacksonville and Mayo School of Graduate Medical Studies, Jacksonville, Florida
^o Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, Arizona
^p Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island
^q Seattle Children's and Regional Medical Center and University of Washington School of Medicine, Seattle, Washington
^r Children's Hospital Memphis and University of Tennessee Graduate School of Medicine, Memphis, Tennessee
^s Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
^t Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia
^u Morgan Stanley Children's Hospital of New York-Presbyterian and Columbia University College of Physicians and Surgeons, New York, New York
^v University of California, Davis, Medical Center and University of California, Davis, School of Medicine, Davis, California
^w Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
^x Columbus Children's Hospital and Ohio State University, Columbus, Ohio

OBJECTIVE. The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis.

METHODS. We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture.

RESULTS. We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with 12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for <12 hours, had significantly higher median cerebrospinal fluid glucose levels (48 mg/dL vs 29 mg/dL) and lower median cerebrospinal fluid protein levels (121 vs 178 mg/dL).

CONCLUSIONS. In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

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Key Words: bacterial meningitis • antibiotic pretreatment • cerebrospinal fluid • children

Abbreviations: CSF—cerebrospinal fluid • ANC—absolute neutrophil count • IQR—interquartile range • WBC—white blood cell

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Accepted Jan 7, 2008.

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