开颅术后脑室外引流（EVD）相关医院获得性脑膜炎：脑脊液诊断标准。
Post craniotomy extra-ventricular drain (EVD) associated nosocomial meningitis: CSF diagnostic criteria.
作者信息
Muñoz-Gómez Sigridh, Wirkowski Elizabeth, Cunha Burke A
机构信息
Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA.
Department of Neurosciences, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
出版信息
Heart Lung. 2015 Mar-Apr;44(2):158-60. doi: 10.1016/j.hrtlng.2015.01.003. Epub 2015 Feb 7.
Because external ventricular drains (EVDs) provide access to cerebrospinal fluid (CSF), there is potential for EVD associated acute bacterial meningitis (EVD-AM). Post-craniotomy, in patients with EVDs, one or more CSF abnormalities are commonly present making the diagnosis of EVD-AM problematic. EVD-AM was defined as elevated CSF lactic acid (>6 nmol/L), plus CSF marked pleocytosis (>50 WBCs/mm(3)), plus a positive Gram stain (same morphology as CSF isolate), plus a positive CSF culture of neuropathogen (same morphology as Gram stained organism). We reviewed 22 adults with EVDs to determine if our four CSF parameters combined accurately identified EVD-AM. No single or combination of <4 CSF parameters correctly diagnosed or ruled out EVD-AM. Combined our four CSF parameters clearly differentiated EVD-AM from one case of pseudomeningitis due to E. cloacae. We conclude that our four CSF criteria combined are useful in diagnosing EVD-AM in adults.
由于外置脑室引流管（EVDs）可用于获取脑脊液（CSF），因此存在发生EVD相关急性细菌性脑膜炎（EVD-AM）的可能性。开颅术后，使用EVDs的患者通常存在一种或多种脑脊液异常情况，这使得EVD-AM的诊断存在问题。EVD-AM的定义为脑脊液乳酸升高（>6 nmol/L），加上脑脊液显著的细胞增多（>50个白细胞/mm³），加上革兰氏染色阳性（与脑脊液分离株形态相同），加上神经病原体的脑脊液培养阳性（与革兰氏染色生物体形态相同）。我们回顾了22例使用EVDs的成年人病例，以确定我们的四项脑脊液参数组合是否能准确识别EVD-AM。少于4项脑脊液参数的单一或组合均不能正确诊断或排除EVD-AM。我们的四项脑脊液参数组合能够明确区分EVD-AM与1例因阴沟肠杆菌引起的假性脑膜炎。我们得出结论，我们的四项脑脊液标准组合有助于诊断成人EVD-AM。
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