Diagnostic accuracy of cerebrospinal fluid gram stain for bacterial meningitis in patients with a suspected central nervous system infection
Clinical Microbiology and Infection·
- DOI
- 10.1016/j.cmi.2026.08.012
- PMID
- 42607834
- PMCID
- —
- OpenAlex
- W7203649109
- Study type
- Journal article
- Publisher
- Elsevier BV
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings clarify the diagnostic performance of a widely recommended rapid test for bacterial meningitis, a life-threatening disease requiring prompt treatment. While positive Gram stain results reliably confirm disease, the low sensitivity means negative results cannot rule out infection, and the overall impact on clinical management appears modest.
Structured evidence summary
Research question
The study evaluated the diagnostic accuracy of cerebrospinal fluid Gram stain for identifying bacterial meningitis in patients undergoing lumbar puncture for suspected central nervous system infection.
Study design
Diagnostic accuracy study comparing CSF Gram stain results against two reference standards: microbiologically confirmed bacterial meningitis and clinical diagnosis scored by two physicians. The study included 1637 episodes in patients aged 16 years or older who underwent lumbar puncture for suspected CNS infection.
Population and setting
Patients aged 16 years or older who underwent lumbar puncture for suspected central nervous system infection. Among 1637 episodes, CSF Gram stain was performed in 1226 cases.
Main findings
CSF Gram stain showed low sensitivity of 53% for microbiologically confirmed bacterial meningitis and 38% for clinically diagnosed cases, but demonstrated excellent specificity of 100% in both groups. The test identified bacterial pathogens in 16 culture-negative cases. Antibiotic treatment was adjusted within 24 hours more frequently in patients with positive Gram stain results compared to negative results (29% versus 10%).
Public-health relevance
The findings clarify the diagnostic performance of a widely recommended rapid test for bacterial meningitis, a life-threatening disease requiring prompt treatment. While positive Gram stain results reliably confirm disease, the low sensitivity means negative results cannot rule out infection, and the overall impact on clinical management appears modest.
Important limitations
This summary relies on the supplied single-article abstract and metadata. Decision-grade interpretation requires access to the full paper, including details on patient selection, laboratory methods, clinical scoring criteria, and potential sources of bias.
GIDS interpretation
This article is discoverable through the bacterial meningitis disease classifier and the diagnostics and treatment topic pathways. It contributes methodological evidence on a standard laboratory test rather than epidemiological surveillance data.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 9 auditable classifier relationships to diseases, places, topics, and study design.