Nosocomial meningitis diagnostic test characteristics: a systematic review

Area of Science:

• Infectious Diseases
• Neurology
• Critical Care Medicine

Background:

• The incidence and diagnostic utility of lumbar puncture for nosocomial meningitis remain unclear in patients without prior neurosurgery or head trauma.
• Hospitalized patients without specific risk factors present a diagnostic challenge for nosocomial meningitis.

Purpose of the Study:

• To systematically review and meta-analyze the accuracy of clinical features and diagnostic utility of lumbar puncture in identifying nosocomial meningitis.
• To evaluate the role of lumbar puncture in ruling out nosocomial meningitis in a general hospitalized population.

Main Methods:

• A comprehensive systematic search of multiple databases (MEDLINE, EMBASE, Cochrane) was conducted until June 5, 2024.
• Studies evaluating clinical features or lumbar puncture for nosocomial meningitis in non-neurosurgical/non-trauma patients were included.
• Exclusion criteria included community-acquired meningitis, outbreaks, HIV-positive individuals, and case reports.

Main Results:

• Six studies were included from 13,302 initial citations.
• The incidence of nosocomial meningitis was determined to be low (very low certainty evidence).
• Among patients undergoing lumbar puncture, 6.9% had positive results, but diagnostic accuracy data were insufficient.

Conclusions:

• Insufficient data exist to assess lumbar puncture's diagnostic accuracy for nosocomial meningitis in this patient group.
• Current evidence suggests a low incidence of nosocomial meningitis in patients without preceding neurosurgery or head trauma.
• Given potential complications and costs, lumbar puncture should be reserved for cases with high clinical suspicion.