The Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Medicine (Baltimore). 2022 Dec 30;101(52):e32418. doi: 10.1097/MD.0000000000032418.
Post-operative central nervous system infections (PCNSIs) are serious complications of craniotomy. Many factors, including patient-related, surgical, and postoperative factors, affect the survival of patients with PCNSIs. Timely and effective implementation of antibiotics targeting pathogenic bacteria is crucial to reduce mortality. Metagenomic next-generation sequencing (mNGS) has been used successfully to detect pathogens associated with infectious diseases. This study was designed to evaluate the factors influencing mortality and to explore the application value of mNGS in patients with PCNSIs. We conducted a retrospective study of patients with PCNSIs in our unit from 1/12/2019 to 28/2/2021. Clinical data, cerebrospinal fluid (CSF) parameters, surgical information, and mNGS results were collected. Follow-up telephone calls were made in June 2021 for 90 days survival after discharge. 99 patients were enrolled, and the overall mortality rate was 36.4% (36/99). Kaplan-Meier survival analysis suggested that the risk factors for poor prognosis included age ≥ 53 years, Glasgow Coma scale (GCS) score ≤ 8, CSF/blood glucose ratio (C/B-Glu) ≤ 0.23, 2 or more operations, mechanical ventilation (MV), and non-mNGS test. MV and poor wound healing were independent risk factors for 90 day mortality according to the multivariate Cox proportional hazards model (OR = 6.136, P = .017, OR = 2.260, P = .035, respectively). Among the enrolled patients, causative pathogens were identified in 37. Gram-negative pathogens were found in 22 (59.5%) patients, and the remaining 15 (40.5%) were Gram-positive pathogens. Univariate analysis showed that white cell count and protein and lactate levels in the CSF of the Gram-negative group were higher than those of the Gram-positive group (P < .05). mNGS and conventional microbiological culture were tested in 34 patients, and the positive detection rate of mNGS was 52.9%, which was significantly higher than that of microbiological culture (52.9% vs 26.5%, χ2 = 4.54, P = .033). The mortality rate of PCNSIs is high, and patients with MV and poor wound healing have a higher mortality risk. Gram-negative pathogens were the predominant pathogens in the patients with PCNSIs. mNGS testing has higher sensitivity and has the potential to reduce the risk of mortality in patients with PCNSIs.
术后中枢神经系统感染（PCNSIs）是开颅术后的严重并发症。许多因素，包括患者相关、手术和术后因素，都会影响 PCNSIs 患者的生存。及时有效地使用针对病原体的抗生素对于降低死亡率至关重要。宏基因组下一代测序（mNGS）已成功用于检测与传染病相关的病原体。本研究旨在评估影响死亡率的因素，并探讨 mNGS 在 PCNSIs 患者中的应用价值。我们对 2019 年 12 月 12 日至 2021 年 2 月 28 日在我院就诊的 PCNSIs 患者进行了回顾性研究。收集了临床资料、脑脊液（CSF）参数、手术信息和 mNGS 结果。2021 年 6 月，对出院后 90 天的生存情况进行了随访电话。共纳入 99 例患者，总体死亡率为 36.4%（36/99）。Kaplan-Meier 生存分析表明，预后不良的危险因素包括年龄≥53 岁、格拉斯哥昏迷评分（GCS）评分≤8、CSF/血糖比值（C/B-Glu）≤0.23、2 次或以上手术、机械通气（MV）和非 mNGS 检测。多因素 Cox 比例风险模型显示 MV 和伤口愈合不良是 90 天死亡率的独立危险因素（OR=6.136，P=.017，OR=2.260，P=.035）。在纳入的患者中，37 例患者确定了病原体。22 例（59.5%）患者发现革兰氏阴性病原体，其余 15 例（40.5%）为革兰氏阳性病原体。单因素分析显示，革兰氏阴性组的 CSF 白细胞计数和蛋白及乳酸水平高于革兰氏阳性组（P<.05）。34 例患者同时进行 mNGS 和常规微生物培养检测，mNGS 的阳性检出率为 52.9%，明显高于微生物培养（52.9%比 26.5%，χ2=4.54，P=.033）。PCNSIs 的死亡率较高，MV 和伤口愈合不良的患者死亡率较高。革兰氏阴性病原体是 PCNSIs 患者的主要病原体。mNGS 检测具有更高的灵敏度，有可能降低 PCNSIs 患者的死亡率。
