Mein J, Lum G
Microbiological Laboratory, Royal Darwin Hospital, Northern Territory, Australia.
Pathology. 1999 Feb;31(1):67-9. doi: 10.1080/003130299105601.
While bacterial antigen detection (BAD) tests have been used on cerebrospinal fluid (CSF) with success in the diagnosis of bacterial infection in developing countries, their value in the developed world has been recently questioned. In Darwin, Northern Territory (NT), there are good diagnostic resources but high rates of infectious disease, so it was unclear which findings were applicable to our own population. This study aimed to determine the utility of the BAD tests in detection of bacterial meningitis from CSF in patients studied at Darwin, using a retrospective review of hospital case records and microbiology laboratory reports, over a 19 month period, and utilising a clinical component in the case definition of bacterial meningitis. The sensitivity of the BAD test in the diagnosis of acute bacterial meningitis was 28.6%, with a specificity of 98.7% and a positive predictive value of 85.7%. The cost per positive test was computed at $240. No cases of bacterial meningitis which were positive on the BAD test were missed on Gram's stain of CSF. We conclude that in our setting BAD tests alone are not sensitive enough to confidently diagnose bacterial meningitis. BAD tests are more costly and offer no advantage in speed of diagnosis or in antibiotic pre-treated patients, compared to routine Gram's stain.
虽然在发展中国家，细菌抗原检测（BAD）试验已成功用于脑脊液（CSF）中细菌感染的诊断，但最近其在发达国家的价值受到了质疑。在北领地（NT）的达尔文市，有良好的诊断资源，但传染病发病率较高，因此尚不清楚哪些研究结果适用于我们当地人群。本研究旨在通过回顾19个月期间的医院病例记录和微生物实验室报告，并在细菌性脑膜炎的病例定义中纳入临床因素，来确定BAD试验在达尔文市研究的患者中从脑脊液检测细菌性脑膜炎的效用。BAD试验诊断急性细菌性脑膜炎的敏感性为28.6%，特异性为98.7%，阳性预测值为85.7%。每次阳性检测的成本计算为240美元。脑脊液革兰氏染色未漏诊任何BAD试验呈阳性的细菌性脑膜炎病例。我们得出结论，在我们的环境中，仅BAD试验不够敏感，无法可靠地诊断细菌性脑膜炎。与常规革兰氏染色相比，BAD试验成本更高，在诊断速度或抗生素预处理患者方面没有优势。
