Time window for positive cerebrospinal fluid broad-range bacterial PCR and Streptococcus pneumoniae immunochromatographic test in acute bacterial meningitis

Abstract

Background: Reliable microbiological tests are essential for the diagnosis of acute bacterial meningitis (ABM). In this study we investigated the time period after the start of antibiotic therapy during which culture, polymerase chain reaction (PCR) and the immunochromatographic test (ICT) are able to detect bacteria in cerebrospinal fluid (CSF). Methods: The study was performed on CSF samples from adults with ABM admitted to the Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2007 to April 2014. In addition to the initial lumbar puncture (LP), the participants underwent one or two more LPs during 10 days following the start of antibiotics. The analyses performed on the CSF samples were culture, PCR and ICT. Results: The study comprised 70 CSF samples from 25 patients with ABM. A bacterium could be identified by CSF culture in 44%, by blood culture in 58% and by PCR in 100% of the patients. There were no positive CSF cultures in samples taken later than the day of starting antibiotics. PCR was positive in 89% on days 1–3, 70% on days 4–6 and 33% on days 7–10. For cases of pneumococcal meningitis, the ICT was positive in 88% on days 1–3, 90% on days 4–6 and 75% on days 7–10. Conclusions: This study shows that PCR is highly sensitive for bacterial detection in CSF samples taken up to 1 week into antibiotic therapy. The ICT is highly sensitive for the detection of pneumococci in CSF samples taken during the first week of antibiotic treatment.

Keywords::

• Acute bacterial meningitis
• diagnosis
• cerebrospinal fluid
• broad-range PCR
• immunochromatographic test

Declaration of interest: The authors have no competing interests. The Vastra Gotaland region supported this study. The funder did not have any influence on study design, data collection, data analysis, data interpretation, writing of the manuscript or the decision to submit the manuscript for publication.