Predictors of bacterial meningitis in adult patients of South West Iran

ABSTRACT

To study the clinical and lab parameters in adult patients with suspected or confirmed bacterial meningitis [BM] to find out the usefull predictors. This was a retrospective study conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. All patients with meningitis aged 18 years or more between 2003 and 2007, with CSF pleocytosis and who had not received antibiotic treatment before lumbar puncture were reviewed. Among 312 patients with CSF pleocytosis, two hundred fifteen [68.9%] had BM and ninety seven [31.1%] had aseptic meningitis [ASM]. The mean age for patients with BM was 34.7 +/- 17.7 years and for ASM was 32.2 +/- 15.5 years [P=0.22, NS]. Sixty percent of the cases of BM and 61.2% of the cases of ASM occurred in men [P=0.70, NS]. We identified the following predictors of BM CSF-WBC count>100 per micro liter, CSF-glucose level<40 mg/dl, CSF-protein level>80 mg/dl. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5%,52.6%,80.2%, 63.7% and 104.1 for CSF-WBC count and 72.1%, 83.5%, 90.6%,57.4% and 164.2% for CSF glucose, and 49.7%, 91.8%, 93.4%,45.2% and 104.5% for CSF protein. The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein it helps in decision making in patients suffering from bacterial meningitis