Epidemiology of Positive Cerebrospinal Fluid Cultures in Pediatrics from 2017 to 2023: A Single-Center Experience

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ID: 327248
2026
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Abstract
Abstract Background Central nervous system (CNS) infections in children can be life-threatening with risk factors for infection influenced by age, immune status, history of CNS hardware, and clinical presentation. Our study aimed to describe the prevalence and epidemiology of positive cerebrospinal fluid (CSF) cultures in children. Methods In this retrospective cohort study of children (<20 years old), we extracted all CSF cultures collected from 2017-2023 at Children’s Healthcare of Atlanta. Multiple cultures obtained within 14 days were grouped into a single hospital episode. Demographic, clinical, and CSF culture data were abstracted from the electronic medical record for hospital episodes with positive CSF cultures. For episodes with >1 positive culture, a primary positive culture was designated as the initial culture if all positive cultures were considered contaminants or the initial culture that was treated. Treatment status was determined based on the clinician’s management documented in the EMR. Characteristics associated with treatment for a positive culture were assessed using univariate analyses at the hospital-episode level. Results We identified 12,167 hospital episodes with a CSF evaluation, of which 876 (7.2%) had at least one positive CSF culture. Among these, 388 (44%) were treated; 239 (62%) occurred in children with CNS hardware. In the 527 episodes among children without a history of CNS hardware, only 149 (28%) were treated. Of the 239 treated episodes with CNS hardware, 234 (98%) underwent a procedural intervention (i.e. removal of shunt) and 5 (2%) were managed with antimicrobials alone. Age, CSF pleocytosis, low glucose, high protein, fever or hypothermia and altered mental status were significantly associated with positive cultures that were treated in patients with and without CNS hardware (all p-value <0.05, Table 1). For patients with a history of CNS hardware, Staphylococcus epidermidis was the most common organism (n=48, 20%). Among infants <2mo without a history of CNS hardware, the most common treated organism was Streptococcus agalactiae (n=35, 54%). For all other age groups without CNS hardware, Streptococcus pneumoniae was most common (50-62%, Figure 1). Conclusion This study provides detailed characterization of positive CSF culture episodes by CNS hardware status and age. CSF culture positivity per hospital episode was low (7.2%) and fewer than half of positive episodes were treated. These findings highlight opportunities for diagnostic stewardship to improve the selection of patients who require CSF evaluation.
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Authors Michael Daugherty, Mark D. Gonzalez, Preeti Jaggi, Pratik A. Patel
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.008
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S4/70833195/piag070.008.pdf
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