Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection

Joost M. Costerus, Cynthia M. C. Lemmens, Diederik van de Beek, Matthijs C. Brouwer

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Abstract

BACKGROUND: Performing cranial imaging prior to lumbar punctures (LPs) in patients with suspected central nervous system (CNS) infections has been associated with delayed treatments and poor outcomes. Various guidelines provide different criteria for cranial imaging prior to LP. METHODS: We describe the use of cranial imaging in a cohort of adult patients with suspected CNS infections, and evaluated adherence to the recommendations made in the Infectious Disease Society of America (IDSA), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Swedish, and Dutch guidelines. We also analyzed the association between cranial imaging and the time between emergency department entrance and intravenous antibiotic administration. RESULTS: From 2012-2015, 203 patients with suspected CNS infections were included, of whom 56 (27%) were diagnosed with CNS infections and 16 were diagnosed with bacterial meningitis (8%). Cranial imaging, in all cases computed tomography (CT), was performed in 130 patients (64%) and led to the deferral of LPs in 7 (5%). Criteria by the IDSA, ESCMID, Swedish, and Dutch guidelines showed indications for imaging in 64%, 39%, 39%, and 40% of patients, respectively. The times between emergency department arrivals and the start of antibiotic therapy between patients with and without CT before LP were similar (median 134 [interquartile range (IQR) 58-292] vs. 141 minutes [IQR 52-227], respectively; Mann-Whitney U P = .74). CONCLUSIONS: A cranial CT prior to LP was done in the majority of patients with a suspected CNS infection, irrespective of guideline indications. The ESCMID, Swedish, and Dutch guidelines were more restrictive in advising imaging, compared to the IDSA guidelines. Performing cranial imaging prior to LP was not associated with treatment delays in this Dutch cohort study.
Original languageEnglish
Pages (from-to)2469-2475
Number of pages7
JournalClinical Infectious Diseases
Volume70
Issue number12
Early online date22 Aug 2019
DOIs
Publication statusPublished - 10 Jun 2020

Keywords

  • CNS infections
  • Cranial imaging
  • Guidelines
  • Lumbar puncture

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