Professor of Medicine, McGovern Medical School UT Health, Houston, TX, USA.
Expert Rev Anti Infect Ther. 2021 Aug;19(8):993-999. doi: 10.1080/14787210.2021.1866544. Epub 2020 Dec 24.
: Healthcare-associated ventriculitis and meningitis occur after neurosurgical procedures, is associated with an adverse outcome in the majority of patients and represent a diagnostic challenge to clinicians. As the cerebrospinal fluid (CSF) culture is the cornerstone of diagnosis, obtaining CSF studies prior to starting antibiotic therapy is key.: This review will evaluate the incidence, risk factors, clinical presentation, diagnosis, empirical intravenous antibiotic therapy, adjunctive intrathecal therapy, microbiology, prognosis, and prevention of HCAVM. We highlight the challenges and limitations of the currently available diagnostic methods and definitions and explore novel technologies. Our review included the search for published literature until June 2020.: Despite available preventive measures, HCAVM continues to occur and to be independently associated with significant neurological morbidity and mortality in the majority of patients. The cornerstone of the diagnosis of HCAVM is a positive CSF culture but the microbiological yield is reduced to ~50% with prior antimicrobial therapy. Although the CSF profile is not affected by antibiotic therapy it has a fair diagnostic accuracy. Future research efforts should concentrate in identifying novel diagnostic tools such as polymerase chain reaction (PCR) or metagenomic sequencing.
: 医疗相关性脑室炎和脑膜炎发生在神经外科手术后，大多数患者的预后不良，对临床医生来说是一个诊断挑战。由于脑脊液 (CSF) 培养是诊断的基石，因此在开始抗生素治疗之前获得 CSF 研究至关重要。：本综述将评估医疗相关性脑室炎和脑膜炎的发生率、危险因素、临床表现、诊断、经验性静脉内抗生素治疗、辅助鞘内治疗、微生物学、预后和预防。我们强调了当前可用的诊断方法和定义的挑战和局限性，并探讨了新技术。我们的综述包括截至 2020 年 6 月已发表文献的搜索。：尽管有预防措施，但医疗相关性脑室炎和脑膜炎仍在发生，并在大多数患者中独立导致严重的神经功能障碍和死亡率。医疗相关性脑室炎和脑膜炎的诊断基石是阳性 CSF 培养，但在进行抗生素治疗之前，微生物学产量降低至约 50%。尽管抗生素治疗不会影响 CSF 特征，但它具有良好的诊断准确性。未来的研究工作应集中于识别新型诊断工具，如聚合酶链反应 (PCR) 或宏基因组测序。
