Our findings lead us to recommend PCGS to ensure a more precise diagnosis of acute meningitis and to reduce the overuse of broad-spectrum antimicrobial agents for both bacterial and aseptic meningitis.īacterial meningitis was defined as clinically evident acute meningitis and positive routine bacterial culture of CSF, regardless of whether antibiotics were administered before the first CSF sample was obtained. For that purpose, we evaluated whether PCGS can discriminate between bacterial and aseptic meningitis, whether the selection of targeted therapies based on PCGS results as opposed to reliance on the Japanese guidelines alone can suppress broad-spectrum antimicrobial use for bacterial meningitis, and whether PCGS as opposed to no Gram stain findings can limit the use of empiric antibiotics for aseptic meningitis. The objective of this study was to clarify whether PCGS performed by clinicians is a valuable tool for the diagnosis and treatment of bacterial and aseptic meningitis in adults. However, the utility of PCGS in treating acute meningitis has never been evaluated, and its clinical impact remains unclear. As PCGS can be performed by clinicians in the emergency room (ER) at any time, our physicians rely on PCGS to help them choose appropriate antibiotics. Īt Okinawa Chubu Hospital in Japan, point-of-care Gram stain (PCGS) has been used routinely for the diagnosis of infectious diseases since 1976. At institutions where Gram staining is not available around the clock, empiric antibiotics are started in 60.8% (45/74) of aseptic meningitis cases in adults. Current guidelines from the Infectious Diseases Society of America recommend Gram staining of the CSF for all suspected meningitis patients in practice, however, this is only possible at the select institutions where Gram stain examination by a microbiology technician is available on demand at any time.
The sensitivity of CSF Gram staining is 60–98%, depending on the patient population, type of bacteria, and previous antimicrobial treatment, and its specificity is nearly 100%. Gram stain of the cerebrospinal fluid (CSF) is a rapid, inexpensive, and accurate method for detecting the etiologic agents of bacterial meningitis. Due to this diagnostic uncertainty, most patients with aseptic meningitis are unnecessarily treated with broad-spectrum antibiotics. There is no single laboratory test that adequately discriminates between bacterial and aseptic meningitis. Distinguishing bacterial meningitis from aseptic meningitis, which is caused mainly by viral infection, is therefore crucial, but is challenging because the symptoms are often similar. At the same time, these broad-spectrum antibiotics should not be administered if not needed: antimicrobial-resistant meningitis, including meropenem-resistant Streptococcus pneumoniae in the CSF, has already been isolated, and its spread in Japan and Taiwan is a cause for concern. Rapid diagnosis of bacterial meningitis and early antimicrobial treatment are essential for a favorable outcome, and empiric broad-spectrum antibiotics should be given as soon as possible to patients with suspected bacterial meningitis. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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