16S rRNA 聚合酶链反应诊断的脑室引流管相关感染发生率：一项前瞻性观察研究。
The incidence of ventriculostomy-related infections as diagnosed by 16S rRNA polymerase chain reaction: A prospective observational study.
机构信息
Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Australia; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
出版信息
J Clin Neurosci. 2024 Aug;126:57-62. doi: 10.1016/j.jocn.2024.05.034. Epub 2024 Jun 5.
BACKGROUND
Ventriculostomy-related infections (VRIs) are reported in about 10 % of patients with external ventricular drains (EVDs). VRIs are difficult to diagnose due to clinical and laboratory abnormalities caused by the primary neurological injury which led to insertion of the EVD. Polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) may enable more accurate diagnosis of VRI. We performed a prospective cohort study to measure the incidence of VRI as diagnosed by 16S rRNA PCR.
METHODS
Patients admitted to intensive care with a primary diagnosis of subarachnoid haemorrhage (SAH), traumatic brain injury (TBI), or intracerebral haemorrhage (ICH), who required an EVD, were assessed for inclusion in this study. Data were extracted from the electronic medical record, bedside charts, or from a prospectively collected database, the Neuroscience Outcomes in Intensive CarE database (NOICE). 16S rRNA PCR was performed on routinely collected CSF as per laboratory protocol. VRI was also diagnosed based on pre-existing definitions.
RESULTS
237 CSF samples from 39 patients were enrolled in the study. The mean patient age was 55.7 years, and 56.4 % were female. The most common primary neurological diagnosis was SAH (61.5 %). The incidence of a positive PCR was 2.6 % of patients (1 in 39) and 0.8 % of CSF samples (2 in 237). The incidence of VRI according to pre-published diagnostic criteria was 2.6 % - 41 % of patients and 0.4 % - 17.6 % of CSF samples. 28.2 % of patients were treated for VRI. Pre-published definitions which relied on CSF culture results had higher specificity and lower false positive rates for predicting a PCR result when compared to definitions incorporating non-microbiological markers of VRI. In CSF samples with a negative 16S rRNA PCR, there was a high proportion of non-microbiological markers of infection, and a high incidence of fever on the day the CSF sample was taken.
CONCLUSIONS
The incidence of VRI as defined as a positive PCR was lower than the incidence of VRI according to several published definitions, and lower than the incidence of VRI as defined as treatment by the clinical team. Non-microbiological markers of VRI may be less reliable than a positive CSF culture in diagnosing VRI.
背景
据报道，约有 10%的外部脑室引流（EVD）患者发生脑室切开相关感染（VRIs）。由于原发性神经损伤导致 EVD 插入，因此会出现临床和实验室异常，这使得 VRIs 的诊断变得困难。脑脊液（CSF）聚合酶链反应（PCR）可能使 VRIs 的诊断更为准确。我们进行了一项前瞻性队列研究，通过 16S rRNA PCR 来测量 VRIs 的发生率。
方法
将原发性蛛网膜下腔出血（SAH）、创伤性脑损伤（TBI）或颅内出血（ICH）患者收入重症监护病房，并需要 EVD 的患者，评估其是否符合纳入本研究的标准。数据从电子病历、床边图表或从前瞻性收集的数据库——神经重症监护的神经科学结果数据库（NOICE）中提取。按照实验室方案，对常规收集的 CSF 进行 16S rRNA PCR。根据预先存在的定义，也可以诊断 VRIs。
结果
本研究共纳入 39 名患者的 237 份 CSF 样本。患者的平均年龄为 55.7 岁，女性占 56.4%。最常见的原发性神经学诊断是 SAH（61.5%）。PCR 阳性的发生率为 2.6%的患者（39 例中的 1 例）和 0.8%的 CSF 样本（237 例中的 2 例）。根据已发表的诊断标准，VRIs 的发生率为 2.6%41%的患者和 0.4%17.6%的 CSF 样本。28.2%的患者接受了 VRIs 治疗。与纳入 VRIs 的非微生物学标志物的定义相比，依赖 CSF 培养结果的已发表定义对预测 PCR 结果具有更高的特异性和更低的假阳性率。在 16S rRNA PCR 阴性的 CSF 样本中，存在大量感染的非微生物学标志物，并且在采集 CSF 样本当天发热的发生率较高。
结论
根据已发表的多个定义，将 PCR 阳性定义为 VRIs 的发生率低于根据几个已发表的定义定义的 VRIs 的发生率，也低于临床团队定义的 VRIs 治疗发生率。VRIs 的非微生物学标志物在诊断 VRIs 方面可能不如 CSF 培养阳性可靠。
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