Morrison AR, Jones MC, Makowski CT, Samuel LP, Ramadan AR, Alangaden GJ, Davis SL, and Kenney RM. Evaluation of the selection of cerebrospinal fluid testing in suspected meningitis and encephalitis. Diagn Microbiol Infect Dis 2022; 102(1):115571.
Diagnostic microbiology and infectious disease
Diagnostic stewardship interventions can decrease unnecessary antimicrobial therapy and microbiology laboratory resources and costs. This retrospective cross-sectional study evaluated factors associated with inappropriate initial cerebrospinal fluid (CSF) testing in patients with suspected community-acquired meningitis or encephalitis. In 250 patients, 202 (80.8%) and 48 (19.2%) were suspected meningitis and encephalitis, respectively. 207 (82.8%) patients had inappropriate and 43 (17.2%) appropriate testing. Any inappropriate CSF test was greatest in the immunocompromised (IC) group (n = 54, 91.5%), followed by non-IC (n = 109, 80.1%) and HIV (n = 44, 80%). Ordering performed on the general ward was associated with inappropriate CSF test orders (adjOR 2.81, 95% CI [1.08-7.34]). Laboratory fee costs associated with excessive testing was close to $300,000 per year. A stepwise algorithm defining empiric and add on tests according to CSF parameters and patient characteristics could improve CSF test ordering in patients with suspected meningitis or encephalitis.
Medical Subject Headings
Adult; Anti-Infective Agents; Encephalitis; Female; Humans; Immunocompromised Host; Male; Meningitis, Bacterial; Middle Aged; Retrospective Studies