Your SlideShare is downloading. ×
0
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Diagnosis of postoperative meningitis using CSF lactate
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Diagnosis of postoperative meningitis using CSF lactate

1,395

Published on

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,395
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
13
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Postoperative Meningitis Diagnosing using CSF Lactate Shashwat Mishra , Deepak Agrawal, BS Sharma Dept of Neurosurgery, All India Institute of Medical Sciences New Delhi-110029
  • 2. INTRODUCTION <ul><li>POSTOPERATIVE MENINGITIS </li></ul><ul><li>A neurosurgical diagnostic dilemma </li></ul><ul><li>Symptoms and signs not dependable </li></ul><ul><li>CSF pleocytosis due to operative insult </li></ul><ul><li>Blood and blood degradation products further confuse the diagnosis </li></ul>
  • 3. Diagnose early and reliably! <ul><li>Need for early diagnosis </li></ul><ul><ul><li>Medical emergency </li></ul></ul><ul><li>Need for confident diagnosis </li></ul><ul><ul><li>Indiscriminate antimicrobial therapy promotes antibiotic resistance </li></ul></ul>
  • 4. Recommended criteria <ul><li>Culture positive, which is the gold standard, along with PMN count >250/cumm </li></ul><ul><li>PMN count>500/cumm (when culture is negative and patient received antibiotics and steroids) </li></ul><ul><li>Leib et al : Clinical and infectious diseases 1999:29 :69-74 </li></ul>
  • 5. Actual Scenario <ul><li>CSF hemorrhagic </li></ul><ul><li>Cultures rarely positive </li></ul><ul><li>CSF Sugar may be spuriously low </li></ul>
  • 6. Aims and objectives <ul><li>To determine biochemical markers which may have increased sensitivity in detecting postoperative meningitis </li></ul>
  • 7. Materials & Methods <ul><li>Prospective study over three month period </li></ul>
  • 8. Materials and methods <ul><li>Test group </li></ul><ul><li>Operated NS patients with fever and clinical suspicion of meningitis </li></ul><ul><li>Control group </li></ul><ul><li>Patients who had lumbar drain/EVD placed prophylactically for CSF , no clinical suspicion of meningitis </li></ul>
  • 9. Materials & Methods <ul><li>Parameters assessed </li></ul><ul><li>CSF cell count (WBC/RBC) </li></ul><ul><li>CSF Sugar & Protein </li></ul><ul><li>CSF Lactate (Using ABG machine*) </li></ul><ul><li>CSF Culture </li></ul><ul><li>* Validated from a standard lab </li></ul>
  • 10. CSF Sampling frequency <ul><li>Test group </li></ul><ul><li>Day 1, 3 and 7 </li></ul><ul><li>Control group </li></ul><ul><li>Day 1, 3 and 5 ,+/- 7 </li></ul>
  • 11. Materials & Methods <ul><li>Corrected CSF WBC count </li></ul><ul><li>(WBC – (RBC /600)) </li></ul>
  • 12. Materials & Methods <ul><li>AIIMS protocol </li></ul><ul><li>All patients with suspected meningitis are started on 3 rd gen Cephalosporin + Aminoglycoside empirically </li></ul>
  • 13. Materials & Methods <ul><li>Statistical tests used </li></ul><ul><ul><li>Chi square test for association between categorical variables </li></ul></ul><ul><ul><li>Students t test </li></ul></ul><ul><ul><li>Pearson’s correlation coefficient </li></ul></ul><ul><ul><li>SPSS 12.0 software </li></ul></ul>
  • 14. Observations <ul><li>Cases-25 </li></ul><ul><li>Controls-14 </li></ul>
  • 15. Observations <ul><li>Age distribution </li></ul>39 14 25 TOTAL 5 2 3 More than 50 yrs 22 8 14 18-50 yrs 12 4 8 Less than 18 yrs TOTAL CONTROL CASE AGEGROUP
  • 16. Observations <ul><li>Sex distribution </li></ul>39 14 25 TOTAL 7 1 6 FEMALE 32 13 19 MALE TOTAL CONTROL CASE SEX
  • 17. Observations <ul><li>Site of CSF Sampling </li></ul>
  • 18. Observations <ul><li>Fever </li></ul>10 0 10 Did not Subside 18 3 15 Subsided 28 3 25 PRESENT TOTAL CONTROL CASE FEVER
  • 19. Observations <ul><li>Incidence of positive culture </li></ul>39 29 10 Total 14 14 0 Control 25 15 10 (40 %) Case Total Culture - Culture + Category
  • 20. RESULTS <ul><li>Mean corrected WBC count </li></ul>0.04 43 312 Day 5/7 0.556 278 371 Day 3 0.547 405 609 Day 1 Mean Corr WBC/mm3 2 tailed significance CONTROL CASE DAY OF SAMPLING
  • 21. Mean CSF: Blood glucose ratio RESULTS .06 .61 .48 Day 5/7 .002 .62 .38 Day 3 .001 .68 .32 Day 1 Mean CSF:Blood Glucose 2 tailed significance CONTROL CASE DAY OF SAMPLING
  • 22. RESULTS Mean CSF lactate .211 3.571 4.436 Day 5/7 .000 3.157 5.076 Day 3 .001 3.257 5.56 Day 1 Mean CSF Lactate values 2 tailed significance CONTROL CASE DAY OF SAMPLING
  • 23. RESULTS Mean CSF lactate trends correlated with culture positivity
  • 24. RESULTS Mean CSF lactate trends correlated with subsidence of fever .005 3.5 5.7 Day 5/7 .42 5.1 4.9 Day 3 .997 5.6 5.6 Day 1 Mean CSF Lactate values 2 tailed significance Responded Didn’t respond DAY OF SAMPLING
  • 25. RESULTS Combination of CSF lactate>5.0 and Sugar ratio < 0.4 Senstivity = 100% , specificity = 60% CULTURE - 25 15 10 Total 9 9 0 Combination - 16 6 10 Combination + TOTAL CULTURE +
  • 26. RESULTS Conventional CSF analysis (CSF WBC >500/cumm) Senstivity = 27% , specificity = 50% CULTURE - 25 10 15 Total 16 5 11 WBC - 9 5 4 WBC + TOTAL CULTURE +
  • 27. Discussion <ul><li>High CSF lactate levels suggestive of infection </li></ul><ul><li>Can be easily determined in an ABG machine with good agreement with standard lab values. </li></ul><ul><li>In combination with low CSF: blood sugar ratio, CSF lactate carries high sensitivity and specificity </li></ul>
  • 28. CONCLUSIONS <ul><li>CSF lactate can be used as single valid parameter in the diagnosis of meningitis. </li></ul><ul><li>Initial baseline determination can be used to monitor therapy. </li></ul><ul><li>Rapid and reliable diagnosis. </li></ul>
  • 29. Thank You

×