Overutilization of Cultures of CSF for Mycobacteria

Abstract
Over a five-year period, 1,883 specimens were cultured for mycobacterium tuberculosis (TB) at our hospital. All cultures were negative, and no cases of tuberculous meningitis were diagnosed. Culture rates (percent of CSF specimens cultured for TB) varied from 74% on the Medicine and Neurology services to 6% on the Pediatric service. These culture rates have been stable for five years. These data suggest that on the Medicine and Neurology services, TB cultures of CSF are persistently overutilized. A simple rule of not culturing CSF for TB if results of the CSF analysis are normal (ie, WBC count ≤4/cu mm, protein level ≤45 mg/dL, and glucose level ≥45 mg/dL) could reduce utilization by at least 50% without adversely affecting quality of care. (JAMA 1984;251:70-72)

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