Gram stain of cerebrospinal fluid (CSF) is widely used in the diagnosis of acute meningitis, however, it is often conducted in the laboratory, as only some hospitals have access to point-of-care Gram stain (PCGS). The purpose of this study was to demonstrate the clinical impact and utility of PCGS in diagnosing and treating both bacterial and aseptic meningitis in adults. This was a hospital-based, retrospective observational study at a referral center in Okinawa, Japan. We reviewed the records of all patients aged 15 years or older who were admitted to the Division of Infectious Diseases between 1995 and 2015 and finally diagnosed with bacterial (n = 34) or aseptic meningitis (n = 97). For bacterial meningitis, we compared the treatments that were actually selected based on PCGS with simulated treatments that would have been based on the Japanese guidelines. For aseptic meningitis, we compared the rates of antibiotic use between real cases where PCGS was available and real cases where it was not. PCGS was the most precise predictor for differentiating between bacterial and aseptic meningitis (sensitivity 91.2%, specificity 98.9%), being superior in this regard to medical histories, vital signs and physical examinations, and laboratory data available in the emergency room (ER). In bacterial meningitis, PCGS reduced the frequency of meropenem use (1/34 = 3.0%) compared with simulated cases in which PCGS was not available (19/34 = 55.9%) (p< 0.001). In aseptic meningitis cases, the rate of antibiotic administration was lower when PCGS was used (38/97 = 39.2%) than when it was not (45/74 = 60.8%) (p = 0.006). PCGS of CSF distinguishes between bacterial and aseptic meningitis more accurately than other predictors available in the ER. Patients with bacterial meningitis are more likely to receive narrower-spectrum antimicrobials when PCGS is used than when it is not. PCGS of CSF thus can potentially suppress the empiric use of antimicrobials for aseptic meningitis.

中文翻译：

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用于治疗成人急性脑膜炎的床旁脑脊液革兰氏染色：一项回顾性观察研究

脑脊液革兰氏染色 (CSF) 广泛用于急性脑膜炎的诊断，但通常在实验室进行，因为只有部分医院可以获得即时革兰氏染色 (PCGS)。本研究的目的是证明 PCGS 在诊断和治疗成人细菌性和无菌性脑膜炎方面的临床影响和实用性。这是在日本冲绳的转诊中心进行的一项基于医院的回顾性观察研究。我们回顾了 1995 年至 2015 年间入住传染病科并最终诊断为细菌性脑膜炎（n = 34）或无菌性脑膜炎（n = 97）的所有 15 岁或以上患者的记录。对于细菌性脑膜炎，我们将根据 PCGS 实际选择的治疗方法与基于日本指南的模拟治疗方法进行了比较。对于无菌性脑膜炎，我们比较了 PCGS 可用的真实案例和没有 PCGS 的真实案例之间的抗生素使用率。PCGS 是区分细菌性脑膜炎和无菌性脑膜炎的最准确预测指标（敏感性 91.2%，特异性 98.9%），在这方面优于病史、生命体征和体格检查以及急诊室 (ER) 可用的实验室数据。在细菌性脑膜炎中，与没有 PCGS 的模拟病例 (19/34 = 55.9%) 相比，PCGS 降低了美罗培南的使用频率 (1/34 = 3.0%) (p < 0.001)。在无菌性脑膜炎病例中，使用 PCGS 时的抗生素使用率 (38/97 = 39.2%) 低于不使用时 (45/74 = 60.8%) (p = 0.006)。CSF 的 PCGS 比 ER 中可用的其他预测指标更准确地区分细菌性脑膜炎和无菌性脑膜炎。与不使用 PCGS 相比，使用 PCGS 时细菌性脑膜炎患者更有可能接受窄谱抗菌药物。因此，CSF 的 PCGS 可以潜在地抑制抗生素治疗无菌性脑膜炎的经验性使用。