TY - JOUR
T1 - Diagnostic Accuracy of Clinical and Laboratory Characteristics in Suspected Nonsurgical Nosocomial Central Nervous System Infections
AU - I.-PACE Study Group
AU - van Zeggeren, Ingeborg E
AU - Pennartz, Charlotte J
AU - Horst, Liora Ter
AU - van de Beek, Diederik
AU - Brouwer, Matthijs C
AU - I-PACE Study Group
AU - Bijlsma, M. W.
AU - Citroen, J.
AU - van Geel, B. M.
AU - Groeneveld, N. S.
AU - Heckenberg, S. G. B.
AU - Jellema, K.
AU - Kester, M. I.
AU - Killestein, J.
AU - Mook, B. B.
AU - Resok, Y. C.
AU - Olie, S. E.
AU - Staal, S. L.
AU - Titulaer, M. J.
AU - van Veen, K. E. B.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Background: The diagnosis of meningitis in non-surgical hospitalized patients is often difficult and diagnostic accuracy of clinical, laboratory, and radiological characteristics is unknown. Aim: To assess diagnostic accuracy for individual clinical characteristics of patients suspected of non-surgical nosocomial central nervous system (CNS) infections. Methods: In a prospective multi-centre cohort study in the Netherlands with adults suspected of CNS infections, consecutive patients who underwent a lumbar puncture for the suspicion of a non-surgical nosocomial CNS infection were included. All episodes were categorized into five final clinical diagnosis categories, as reference standard: CNS infection, CNS inflammatory disease, systemic infection, other neurological disease, or non-systemic, non-neurological disease. Findings: Between 2012 and 2022, 114 out of 1275 (9%) patients included in the cohort had suspected non-surgical nosocomial CNS infection: 16 (14%) had a confirmed diagnosis, including four (25%) with bacterial meningitis, nine (56%) with viral CNS infections, two (13%) fungal meningitis, and one (6%) parasitic meningitis. Diagnostic accuracy of individual clinical characteristics was generally low. Elevated CSF leucocyte count had the highest sensitivity (81%; 95% confidence interval (CI): 54–96) and negative predictive value (NPV) (96%; 95% CI: 90–99). When combining the presence of abnormalities in neurological or CSF examination, sensitivity for diagnosing a CNS infection was 100% (95% CI: 79–100) and NPV 100% (95% CI: 78–100). CSF examination changed clinical management in 47% of patients. Conclusion: Diagnostic accuracy for individual clinical characteristics was low, with elevated CSF leucocyte count having the highest sensitivity and NPV.
AB - Background: The diagnosis of meningitis in non-surgical hospitalized patients is often difficult and diagnostic accuracy of clinical, laboratory, and radiological characteristics is unknown. Aim: To assess diagnostic accuracy for individual clinical characteristics of patients suspected of non-surgical nosocomial central nervous system (CNS) infections. Methods: In a prospective multi-centre cohort study in the Netherlands with adults suspected of CNS infections, consecutive patients who underwent a lumbar puncture for the suspicion of a non-surgical nosocomial CNS infection were included. All episodes were categorized into five final clinical diagnosis categories, as reference standard: CNS infection, CNS inflammatory disease, systemic infection, other neurological disease, or non-systemic, non-neurological disease. Findings: Between 2012 and 2022, 114 out of 1275 (9%) patients included in the cohort had suspected non-surgical nosocomial CNS infection: 16 (14%) had a confirmed diagnosis, including four (25%) with bacterial meningitis, nine (56%) with viral CNS infections, two (13%) fungal meningitis, and one (6%) parasitic meningitis. Diagnostic accuracy of individual clinical characteristics was generally low. Elevated CSF leucocyte count had the highest sensitivity (81%; 95% confidence interval (CI): 54–96) and negative predictive value (NPV) (96%; 95% CI: 90–99). When combining the presence of abnormalities in neurological or CSF examination, sensitivity for diagnosing a CNS infection was 100% (95% CI: 79–100) and NPV 100% (95% CI: 78–100). CSF examination changed clinical management in 47% of patients. Conclusion: Diagnostic accuracy for individual clinical characteristics was low, with elevated CSF leucocyte count having the highest sensitivity and NPV.
KW - CNS infection
KW - Encephalitis
KW - Meningitis
KW - Non-surgical nosocomial
UR - http://www.scopus.com/inward/record.url?scp=85184044423&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2023.12.015
DO - 10.1016/j.jhin.2023.12.015
M3 - Article
C2 - 38219837
SN - 0195-6701
VL - 145
SP - 99
EP - 105
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
ER -