Cerebrospinal fluid (CSF) culture remains the gold standard in diagnosis of bacterial meningitis, and should be attempted as soon as clinically safe. The chance of growing bacteria reduces after only 1–2 hours of antibiotic (although PCR may help identify the two most likely organisms—meningococcus and pneumococcus) (Grade A).
CSF samples taken up to 96 hours after pretreatment may give useful results regarding CSF white cell count and is worth doing to exclude or confirm meningitis (Grade B).
Normal CSF does not always rule out bacterial meningitis and, therefore, repeat CSF analysis should be considered and antimicrobial therapy started immediately if there is any clinical concern of meningitis (Grade B).
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