Department of Neurology, University Hospital of Heidelberg, Germany.
J Neurol Sci. 2013 Feb 15;325(1-2):46-50. doi: 10.1016/j.jns.2012.11.014. Epub 2012 Dec 28.
Patients with severe acute stroke are at high risk for systemic infections which are associated with an increase in morbidity and mortality; nevertheless current guidelines do not recommend prophylactic antibiotic therapy. Sensitive detection of pathogens in the blood is desirable to guide early antibiotic therapy. We studied the yield of blood culture testing and microbiological PCR-based methods for early detection of post-stroke bacteremia.
Serial blood culture tests either during the first fever episode (>38.5°C) or 24h after admission were performed every 12h for up to 96h after admission. Additionally, microbiological PCR-based techniques for the detection of microbiological pathogens were performed once during the first fever episode prior to initiating antibiotic treatment.
21 severely affected acute stroke patients deemed at high risk for systemic infections (median (interquartile range (IQR)) at admission NIHSSS 19 (15-30) were enrolled; 20 patients were intubated within 5h after ICU admission. All patients developed clinical signs and laboratory constellations compatible with systemic infections within 36h after admission. However, no patient had pathogenic bacteria either in serial blood culture analyses during the first 96h after admission or by PCR-based techniques.
Very early bacteremia seems not to be a feature of severe stroke in patients despite signs of early immune system depression and frequent subsequent evidence of infection including pneumonia. Consequently our data suggests, that routine early blood-based standard or molecular microbiological assays do not reveal bacteremia, this finding questions the usefulness of their routine performance in this context.
患有严重急性脑卒中的患者存在发生全身感染的高风险，这会增加发病率和死亡率；然而，目前的指南并不建议预防性使用抗生素治疗。在血液中敏感地检测病原体有助于指导早期抗生素治疗。我们研究了血液培养检测和基于微生物 PCR 的方法在检测卒中后菌血症方面的应用。
在首次发热（>38.5°C）期间或入院后 24 小时内，每隔 12 小时进行一次连续的血培养检测，最长检测时间为入院后 96 小时。此外，在开始抗生素治疗前，在首次发热期间还进行了一次基于微生物 PCR 的技术检测以检测微生物病原体。
21 名患有严重脑卒中且被认为存在全身感染高风险的患者（入院时 NIHSSS 中位数（四分位距（IQR））为 19（15-30）被纳入研究；20 名患者在入 ICU 后 5 小时内插管。所有患者在入院后 36 小时内均出现与全身感染相符的临床症状和实验室表现。然而，在入院后的前 96 小时内，连续的血培养分析或基于 PCR 的技术均未发现致病性细菌。
尽管存在早期免疫系统抑制和随后经常出现感染的迹象，包括肺炎，但严重脑卒中患者似乎没有早期菌血症的特征。因此，我们的数据表明，常规的早期基于血液的标准或分子微生物学检测并不能发现菌血症，这一发现质疑了在这种情况下常规进行这些检测的有用性。
