Related Experiment Video
Updated: Jun 9, 2025
Inducing Meningococcal Meningitis Serogroup C in Mice via Intracisternal Delivery
Published on: November 5, 2019
Nosocomial meningitis diagnostic test characteristics: a systematic review
David Granton1, Joseph Brown2, Shannon M Fernando3,4
1Department of Medicine, University of Toronto, Toronto, ON, Canada.
Background:
The incidence of nosocomial meningitis, and utility of lumbar puncture, is unclear in hospitalized patients without preceding neurosurgery or head trauma.
Aim:
We planned for a systematic review and meta-analysis to evaluate accuracy of clinical features and diagnostic utility of lumbar puncture in nosocomial meningitis.
Methods:
We searched MEDLINE, MEDLINE In-Process/ePubs, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception until June 5, 2024. We included studies evaluating utility of clinical features, or lumbar puncture, to rule out nosocomial meningitis in patients without preceding neurosurgery or head trauma. We excluded studies examining community acquired meningitis, outbreaks, HIV positive individuals, and case reports. Outcomes included incidence, risk factors and diagnostic accuracy of clinical features for nosocomial meningitis, and lumbar puncture complications. Given few included studies and heterogeneity, we could only summarize incidence of nosocomial meningitis.
Findings:
Of 13,302 citations, we reviewed 197 manuscripts and included 6. There were 23 of 333 (6.9%, very low certainty) positive lumbar punctures among individuals who underwent lumbar puncture to rule out nosocomial meningitis.
Conclusions:
There were insufficient data to evaluate the diagnostic accuracy of lumbar puncture in nosocomial meningitis in patients without preceding neurosurgery or head trauma. Very low certainty evidence indicates the incidence of nosocomial meningitis is low in this population. Given complications and costs associated with lumbar puncture, future studies should evaluate its utility in nosocomial meningitis. In the meantime, it may be reasonable to reserve lumbar puncture to instances of high suspicion.
Insights
The incidence of nosocomial meningitis is low in hospitalized patients without head trauma or neurosurgery. Lumbar puncture utility is unclear, suggesting its use only in high-suspicion cases.
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.
More Related Videos
09:07Author Spotlight: Accelerating Diagnostic Accuracy with Direct Identification of Gram-Negatives from Blood Culture Bottles
Published on: May 24, 2024
08:36Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
