Alqayoudhi Abdullah, Nielsen Maryke, O'Sullivan Nicola, Corcoran Mary, Gavin Patrick J, Butler Karina M, Cunney Robert, Drew Richard J
From the *Department of Paediatric Infectious Diseases, and †Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland; ‡Irish Meningitis and Sepsis Reference Laboratory, and §Irish Pneumococcal Reference Laboratory, Temple Street Children's University Hospital, Dublin 7, Ireland; ¶Department of Paediatric Infectious Diseases, Our Lady's Childrens' Hospital Crumlin, Dublin 12, Ireland; ‖UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; **Department of Clinical Microbiology, Rotunda Hospital, Dublin 1, Ireland; and ††Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Pediatr Infect Dis J. 2017 Sep;36(9):833-836. doi: 10.1097/INF.0000000000001608.
The aim of this retrospective study was to review the diagnostic accuracy of real-time polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) samples for Streptococcus pneumoniae DNA in comparison with traditional bacterial culture. The hypothesis was that PCR is more sensitive than culture and would detect more cases of pneumococcal meningitis, particularly in children treated with antimicrobials before CSF sampling occurred. Patients younger than 16 years of age who had a CSF sample tested for S. pneumoniae DNA by PCR between 2004 and 2015 were included. A total of 2025 samples were included, and the PCR had a sensitivity of 100% and specificity of 98% for the detection of S. pneumoniae DNA in comparison with culture. Of the 28 culture negative/PCR positive cases, 25 (89%) were probable meningitis cases and only 3 (11%) were suspected false positive results. Nineteen (76%) of the 25 probable cases required ICU admission, and 3 died (12%). Six different serotypes were found in the culture positive patients (18C, 6B, 14, 22F, 7F and 33F). This study demonstrates that PCR testing of CSF samples for S. pneumoniae is sensitive and specific when compared with culture. PCR is particularly useful in detecting those cases where culture is negative, perhaps relating to pre-CSF sampling administration of antimicrobials.
本回顾性研究的目的是，对比传统细菌培养法，评估脑脊液（CSF）样本实时聚合酶链反应（PCR）检测肺炎链球菌DNA的诊断准确性。研究假设为，PCR比培养法更敏感，能检测出更多肺炎球菌性脑膜炎病例，尤其是在脑脊液采样前接受过抗菌药物治疗的儿童中。纳入2004年至2015年间年龄小于16岁、脑脊液样本通过PCR检测肺炎链球菌DNA的患者。共纳入2025份样本，与培养法相比，PCR检测肺炎链球菌DNA的灵敏度为100%，特异性为98%。在28例培养阴性/PCR阳性病例中，25例（89%）可能为脑膜炎病例，仅3例（11%）怀疑为假阳性结果。25例可能病例中有19例（76%）需要入住重症监护病房，3例死亡（12%）。在培养阳性患者中发现了6种不同血清型（18C、6B、14、22F、7F和33F）。本研究表明，与培养法相比，脑脊液样本PCR检测肺炎链球菌具有敏感性和特异性。PCR在检测培养阴性的病例中特别有用，这可能与脑脊液采样前使用抗菌药物有关。
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