{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:23:50Z","timestamp":1793402630664,"version":"4.5.0"},"reference-count":10,"publisher":"American Academy of Pediatrics (AAP)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,1]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n We aimed to describe the cerebrospinal fluid (CSF) profiles of infants \u226460 days old with bacterial meningitis and the characteristics of infants with bacterial meningitis who did not have CSF abnormalities.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We included infants \u226460 days old with culture-positive bacterial meningitis who were evaluated in the emergency departments of 11 children\u2019s hospitals between July 1, 2011, and June 30, 2016. From medical records, we abstracted clinical and laboratory data. For infants with traumatic lumbar punctures (CSF red blood cell count of \u226510\u2009000 cells per mm3), we used a red blood cell count\/white blood cell (WBC) count correction factor of 1000:1 to determine the corrected CSF WBC count. We calculated the sensitivity for bacterial meningitis of a CSF Gram-stain and corrected CSF pleocytosis (\u226516 WBCs per mm3 for infants \u226428 days old and \u226510 WBCs per mm3 for infants 29\u201360 days old).<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Among 66 infants with bacterial meningitis, the sensitivity of a CSF Gram-stain was 71.9% (95% confidence interval [CI]: 59.2\u201382.4), and the sensitivity of corrected CSF pleocytosis was 80.3% (95% CI: 68.7\u201389.1). The sensitivity of combining positive Gram-stain results with corrected CSF pleocytosis was 86.4% (95% CI: 75.7\u201393.6). Of 9 infants with meningitis who had a negative Gram-stain result and no corrected CSF pleocytosis, 8 (88.9%) had either an abnormal peripheral WBC count (&gt;15\u2009000 or &lt;5000 cells per \u03bcL) or bandemia &gt;10%.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Most infants \u226460 days old with bacterial meningitis have CSF pleocytosis or a positive Gram-stain result. Infants with no CSF pleocytosis and a negative Gram-stain result are unlikely to have bacterial meningitis in the absence of other laboratory abnormalities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2019-0202","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T14:16:02Z","timestamp":1575296162000},"page":"979-982","source":"Crossref","is-referenced-by-count":11,"title":["Cerebrospinal Fluid Profiles of Infants \u226460 Days of Age With Bacterial Meningitis"],"prefix":"10.1542","volume":"9","author":[{"given":"Eduardo","family":"Fleischer","sequence":"first","affiliation":[{"name":"Section of Pediatric Emergency Medicine, Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie E.","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University and Lucile Packard Children\u2019s Hospital Stanford, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanyukta","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne G.","family":"DePorre","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Children\u2019s Mercy Hospital, Kansas City, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianna C.","family":"Leazer","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Children\u2019s Hospital of The King\u2019s Daughters, Norfolk, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Marble","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Feinberg School of Medicine, Northwestern University and Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura F.","family":"Sartori","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University and Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Section of Pediatric Emergency Medicine, Departments of Pediatrics and"},{"name":"Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,12,1]]},"reference":[{"issue":"3","key":"2021120817070705700_B1","doi-asserted-by":"crossref","first-page":"e190874","DOI":"10.1001\/jamanetworkopen.2019.0874","article-title":"Prevalence of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life: a systematic review and meta-analysis","volume":"2","author":"Biondi","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2021120817070705700_B2","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1016\/j.cmi.2016.01.007","article-title":"ESCMID guideline: diagnosis and treatment of acute bacterial meningitis","volume":"22","author":"van de Beek","year":"2016","journal-title":"Clin Microbiol Infect"},{"issue":"5","key":"2021120817070705700_B3","doi-asserted-by":"crossref","first-page":"e20163268","DOI":"10.1542\/peds.2016-3268","article-title":"Epidemiology of cerebrospinal fluid cultures and time to detection in term infants","volume":"139","author":"Leazer","year":"2017","journal-title":"Pediatrics"},{"issue":"1","key":"2021120817070705700_B4","doi-asserted-by":"crossref","first-page":"e20170476","DOI":"10.1542\/peds.2017-0476","article-title":"The epidemiology, management, and outcomes of bacterial meningitis in infants","volume":"140","author":"Ouchenir","year":"2017","journal-title":"Pediatrics"},{"key":"2021120817070705700_B5","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jpeds.2018.04.033","article-title":"Epidemiology and etiology of invasive bacterial infection in infants \u226460 days old treated in emergency departments","volume":"200","author":"Woll","year":"2018","journal-title":"J Pediatr"},{"issue":"3","key":"2021120817070705700_B6","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/INF.0b013e318243e502","article-title":"Cerebrospinal fluid enrichment broth cultures rarely contribute to the diagnosis of bacterial meningitis","volume":"31","author":"Shah","year":"2012","journal-title":"Pediatr Infect Dis J"},{"issue":"3","key":"2021120817070705700_B7","doi-asserted-by":"crossref","first-page":"e20173405","DOI":"10.1542\/peds.2017-3405","article-title":"Cerebrospinal fluid reference values for young infants undergoing lumbar puncture","volume":"141","author":"Thomson","year":"2018","journal-title":"Pediatrics"},{"issue":"5","key":"2021120817070705700_B8","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.annemergmed.2016.10.008","article-title":"Interpretation of cerebrospinal fluid white blood cell counts in young infants with a traumatic lumbar puncture","volume":"69","author":"Lyons","year":"2017","journal-title":"Ann Emerg Med"},{"issue":"1","key":"2021120817070705700_B9","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1001\/jama.297.1.52","article-title":"Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis","volume":"297","author":"Nigrovic","year":"2007","journal-title":"JAMA"},{"key":"2021120817070705700_B10","article-title":"Application of the bacterial meningitis score for infants aged 0 to 60 days [published online ahead of print December 10, 2018]","author":"Rees","journal-title":"J Pediatric Infect Dis Soc"}],"container-title":["Hospital 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