Xu Lijun, Zhao Handan, Zhou Minghan, Lang Guanjing, Lou Haiyan
National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Front Microbiol. 2021 Oct 15;12:742931. doi: 10.3389/fmicb.2021.742931. eCollection 2021.
The clinical relevance of single or repeated episodes of spp. in cerebrospinal fluid (CSF) in adult patients is debatable. Forty-two patients with positive episodes in CSF were enrolled in this retrospective study. A total of 42.9% (18/42) were determined to have probable (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6-126.1), = 0.004], lumbar drainage [OR: 5.8 (1.5-23.3), = 0.009], VP shunt [(OR: 5.6 (1.2-25.8), = 0.020)], external ventricular drainage [OR: 4.7 (1.3-17.7), = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3-18.1), = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8-50.5), = 0.004] were risk factors associated with PCM. A single CSF episode for the diagnosis of PCM had 7.7% (0.4-37.9%) sensitivity and 20.7% (8.7-40.3%) specificity, whereas repeated episodes of had 66.7% (41.2-85.6%) sensitivity and 95.8% (76.9-99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5-208.6) for PCM patients compared with non-PCM patients ( = 0.001). Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.
成年患者脑脊液（CSF）中出现单次或反复的 spp. 感染的临床相关性存在争议。本回顾性研究纳入了42例脑脊液检测呈阳性的患者。共有42.9%（18/42）的患者被判定为可能患有 （PCM）。神经外科手术[比值比（OR）（95%置信区间），OR：14.4（1.6 - 126.1），P = 0.004]、腰椎引流[OR：5.8（1.5 - 23.3），P = 0.009]、脑室腹腔分流术[OR：5.6（1.2 - 25.8），P = 0.020]、脑室外引流[OR：4.7（1.3 - 17.7），P = 0.018]、CRP≥10.0 mg/L[OR：4.9（1.3 - 18.1），P = 0.034]以及术后使用广谱抗生素[OR：9.5（1.8 - 50.5），P = 0.004]是与PCM相关的危险因素。单次脑脊液 感染用于诊断PCM的敏感性为7.7%（0.4 - 37.9%），特异性为20.7%（8.7 - 40.3%），而反复感染的敏感性为66.7%（41.2 - 85.6%），特异性为95.8%（76.9 - 99.8%）。PCM患者与非PCM患者在影像学检查或脑脊液特征方面未发现显著差异。共有37.5%（9/24）没有PCM的患者接受了经验性抗真菌治疗，而88.9%（16/18）患有PCM的患者接受了抢先抗真菌治疗。PCM患者的住院死亡率为50.0%（9/18）。与非PCM患者相比，PCM患者的死亡比值比为23.0（2.5 - 208.6）（P = 0.001）。脑脊液样本单次和反复检测呈阳性对于PCM诊断的有效性都较低，这表明迫切需要新的PCM诊断算法策略。对于有危险因素的可疑患者应立即开始经验性抗真菌治疗。
