Stubljar David, Kopitar Andreja Natasa, Groselj-Grenc Mojca, Suhadolc Kristina, Fabjan Teja, Skvarc Miha
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.
J Clin Microbiol. 2015 Apr;53(4):1239-44. doi: 10.1128/JCM.03052-14. Epub 2015 Feb 4.
Children with temporary external ventricular drains (EVD) are prone to nosocomial infections. Diagnosis of bacterial meningitis and ventriculitis in these children is challenging due to frequent blood contamination of cerebrospinal fluid (CSF) and the presence of chemical ventriculitis. The aim of this study was to compare diagnostic accuracy of presepsin (sCD14-ST), a novel biomarker of bacterial infection in CSF, to predict bacterial infection in comparison to the accuracy of established biomarkers like those demonstrated in biochemical analysis of CSF. We conducted a prospective study with 18 children with suspected bacterial meningitis or ventriculitis who had 66 episodes of disease. CSF samples were taken from external ventricular drainage. We measured presepsin in CSF, as well as CSF leukocyte count, glucose, and proteins. CSF was also taken to prove bacterial infection with culture methods or with 16S rRNA gene broad-range PCR (SepsiTest; Molzym, Germany). Infection was clinically confirmed in 57 (86%) episodes of suspected meningitis or ventriculitis. Chemical ventriculitis was diagnosed in 9 (14%) episodes of suspected meningitis or ventriculitis. Diagnostic accuracies presented as area under the curve (AUC) for sCD14-ST, leukocytes, and proteins measured in CSF were 0.877 (95% confidence interval [CI], 0.793 to 0.961), 0.798 (95% CI, 0.677 to 0.920), and 0.857 (95% CI, 0.749 to 0.964), respectively. With CSF culture, we detected bacteria in 17 samples, compared to 37 detected with broad-range PCR. It was found that presepsin was present at a significantly higher level in children with clinically proven ventriculitis than in those without meningitis or ventriculitis. Diagnostic accuracies of presepsin were superior to those of leukocytes or proteins in CSF. Presepsin-guided 16S rRNA gene PCR could be used in everyday clinical practice to improve etiological diagnosis of meningitis and ventriculitis and to prescribe more appropriate antibiotics.
患有临时体外脑室引流管（EVD）的儿童容易发生医院感染。由于脑脊液（CSF）频繁受到血液污染以及存在化学性脑室炎，这些儿童细菌性脑膜炎和脑室炎的诊断具有挑战性。本研究的目的是比较脑脊液中细菌感染的新型生物标志物可溶性CD14亚型（sCD14-ST）与脑脊液生化分析中已确立的生物标志物的准确性，以预测细菌感染。我们对18例疑似细菌性脑膜炎或脑室炎的儿童进行了一项前瞻性研究，这些儿童共出现66次发病情况。脑脊液样本取自体外脑室引流。我们测量了脑脊液中的可溶性CD14亚型、脑脊液白细胞计数、葡萄糖和蛋白质。还采集脑脊液通过培养方法或16S rRNA基因广谱PCR（SepsiTest；德国Molzym公司）来证实细菌感染。在57例（86%）疑似脑膜炎或脑室炎病例中临床确诊为感染。在9例（14%）疑似脑膜炎或脑室炎病例中诊断为化学性脑室炎。脑脊液中测量的sCD14-ST、白细胞和蛋白质的诊断准确性以曲线下面积（AUC）表示，分别为0.877（95%置信区间[CI]，0.793至0.961）、0.798（95%CI，0.677至0.920）和0.857（95%CI，0.749至0.964）。通过脑脊液培养，我们在17个样本中检测到细菌，而通过广谱PCR检测到37个样本。结果发现，临床确诊为脑室炎的儿童脑脊液中可溶性CD14亚型水平明显高于无脑膜炎或脑室炎的儿童。可溶性CD14亚型的诊断准确性优于脑脊液中的白细胞或蛋白质。可溶性CD14亚型指导下的16S rRNA基因PCR可用于日常临床实践，以改善脑膜炎和脑室炎的病因诊断，并开具更合适的抗生素。
