Chatzopoulos Kyriakos, Shannon Samantha, Schuetz Audrey N
Department of Laboratory Medicine and Pathology Division of Clinical Microbiology Mayo Clinic, Rochester, MN, USA.
Department of Laboratory Medicine and Pathology Division of Clinical Microbiology Mayo Clinic, Rochester, MN, USA.
Anaerobe. 2020 Aug;64:102246. doi: 10.1016/j.anaerobe.2020.102246. Epub 2020 Jul 25.
Anaerobic meningitis is a rare serious clinical condition which mainly affects vulnerable populations and patients with predisposing factors such as head trauma, prior neurosurgical procedures or implantable medical devices such as ventriculoperitoneal shunts or ventricular drains. In this study we retrieved data from aerobic and anaerobic cultures of cerebrospinal (CSF) or ventricular fluid ordered over a 5 year period at our institution. A total of 8868 aerobic and 594 anaerobic cultures were performed from 2013 to 2017. 24/594 (4%) anaerobic cultures from 14 patients were positive for anaerobes. Only 3 of those patients were diagnosed clinically with anaerobic meningitis, each with predisposing factors, while anaerobes (Cutibacterium acnes and Clostridium perfringens) recovered from the remaining 21 patients were regarded as contaminants. 129/8868 (1.45%) aerobic CSF cultures were positive for anaerobes. 120/129 (93%) cultures recovered C. acnes while non-C. acnes anaerobes were recovered in the remaining 9 cultures and were deemed to be contaminants. In the majority of situations, recovery of C. acnes from CSF or ventricular fluid was regarded as contamination. Our cohort included 18 patients with a ventriculoperitoneal shunt or ventricular drain, 17 of whom had C. acnes recovered from either aerobic or anaerobic culture, and 10 were treated with targeted antibiotics and surgical replacement of the shunt or drain. Anaerobic culture of the CSF or ventricular fluid aided in identification of two patients with anaerobic meningitis and an additional two patients with shunt infection. Anaerobe culture of CSF is important in identification of anaerobic meningitis, as growth of anaerobes other than C. acnes is rare from aerobic CSF culture.
厌氧性脑膜炎是一种罕见的严重临床病症，主要影响弱势群体以及有易感因素的患者，如头部外伤、既往神经外科手术或植入式医疗设备（如脑室腹腔分流管或脑室引流管）。在本研究中，我们检索了本机构5年期间脑脊液（CSF）或脑室液需氧和厌氧培养的数据。2013年至2017年共进行了8868次需氧培养和594次厌氧培养。14例患者的24/594（4%）次厌氧培养中厌氧菌呈阳性。其中只有3例患者临床诊断为厌氧性脑膜炎，每例都有易感因素，而从其余21例患者中培养出的厌氧菌（痤疮丙酸杆菌和产气荚膜梭菌）被视为污染物。129/8868（1.45%）次脑脊液需氧培养中厌氧菌呈阳性。120/129（93%）次培养中分离出痤疮丙酸杆菌，其余9次培养中分离出非痤疮丙酸杆菌厌氧菌，被视为污染物。在大多数情况下，从脑脊液或脑室液中培养出痤疮丙酸杆菌被视为污染。我们的队列包括18例有脑室腹腔分流管或脑室引流管的患者，其中17例在需氧或厌氧培养中培养出痤疮丙酸杆菌，10例接受了靶向抗生素治疗并进行了分流管或引流管的手术更换。脑脊液或脑室液的厌氧培养有助于识别2例厌氧性脑膜炎患者和另外2例分流管感染患者。脑脊液厌氧菌培养对于识别厌氧性脑膜炎很重要，因为从脑脊液需氧培养中很少能培养出除痤疮丙酸杆菌以外的厌氧菌。
