An infant case of recurrent bacterial meningitis successfully treated with cerebrospinal fluid glucose/blood glucose ratio monitoring: A narrative review on the appropriate duration of antimicrobial therapy

Abstract

The patient was a 2-month-old boy who was treated for 21 days with antimicrobial therapy for bacterial meningitis caused by Escherichia coli, starting at 13 days of age. On the third day after completing treatment, he developed fever and apnea, followed by seizures. Cerebrospinal fluid (CSF) examination revealed elevated cell count and protein levels and decreased sugar levels. We diagnosed a relapse of bacterial meningitis. Due to the prolonged and intense inflammatory response resulting from the complication of subdural edema, the optimal duration of antimicrobial therapy was unclear. The duration of treatment was determined using an elevated CSF glucose/blood glucose ratio as an indicator for ending therapy. The patient has not experienced a relapse. The appropriate index for determining the duration of antimicrobial therapy remains to be elucidated. Herein, we report this case and review the usefulness of the CSF glucose/blood glucose ratio as a marker.