Cerebrospinal fluid inflammatory markers to differentiate between neonatal bacterial meningitis and sepsis: A prospective study of diagnostic accuracy

International Journal of Infectious Diseases, vol. 142, pp. 106970

Abstract

OBJECTIVES: We evaluated the diagnostic accuracy of cerebrospinal fluid (CSF) inflammatory markers for diagnosing bacterial meningitis in neonates with sepsis and/or meningitis. METHODS: Cases were identified from a prospective multicenter study including patients aged 0-3 months with Group B Streptococcal (GBS) or Escherichia coli culture positive sepsis/meningitis. CSF CXCL10, MDC, IL-6, IL-8, IL-10, TNF- α, MIF, IL-1RA, CXCL13, IL-1β, CRP and procalcitonin concentrations were measured with Luminex technology. RESULTS: In 61/373 patients (17%) residual CSF from the lumbar puncture was available, of whom 16 (26%) had definitive meningitis, 15 (25%) probable meningitis and 30 (49%) had sepsis. All biomarkers were detectable in CSF and showed significantly higher concentrations in definitive meningitis versus sepsis patients and six biomarkers in probable meningitis versus sepsis patients. Discrimination between definitive meningitis and sepsis was excellent for IL-1RA (area under the receiver operating characteristic curve [AUC] 0.93), TNF-α (AUC 0.92), CXCL10 (AUC 0.90), IL-1β (AUC 0.92), IL-6 (AUC 0.94), IL-10 (AUC 0.93) and a combination of IL-1RA, TNF-α, CXCL-10 and CSF leukocyte count (AUC 0.95). CSF leukocyte count remained the predictor with the highest diagnostic accuracy (AUC 0.96). CONCLUSION: CSF inflammatory markers can be used to differentiate between neonatal sepsis and meningitis.

Authors 7

1. Nina S Groeneveld

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

2. Sabine E. Olie

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

3. Douwe H. Visser

   Emma Kinderziekenhuis · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands

4. Linde Snoek

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

5. Diederik van de Beek

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

6. Matthijs C. Brouwer

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

7. Merijn W. Bijlsma corresponding

   Amsterdam Neuroscience · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatrics, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.bijlsma@amsterdamumc.nl