Khatod Yash, Bohra Gopal Krishana, Kumar Deepak, Meena Durga Shankar, Ramankutty Neetha Thayil, Gadepalli Ravisekhar, Panda Samhita, Kaur Navneet, Kanagiri Tejasvi
Department of Infectious Diseases, All India Institute of Medical Sciences, Jodhpur, India.
Department of Infectious Diseases, All India Institute of Medical Sciences, OPD block, First Floor, B Block, Jodhpur, 342005, India.
BMC Infect Dis. 2025 May 29;25(1):769. doi: 10.1186/s12879-025-10565-7.
Acute and subacute central nervous system (CNS) infections represent critical medical emergencies requiring prompt and accurate management. The practices in managing such cases at various primary or secondary health-care facilities, where patients usually have first contact and receive preliminary treatment, can have impact on diagnosis and outcomes. The present study aimed to investigate the differences in microbiological confirmation rates and outcomes between referred and non-referred cases of community-acquired CNS infections at a tertiary centre, while identifying gaps in the management practices at first-contact healthcare facilities.
This prospective study was conducted at the All India Institute of Medical Sciences (AIIMS) Jodhpur. All referred and non-referred cases with suspected CNS infections underwent microbiological evaluation and all efforts were made for etiological identification by utilising specimens from CNS- sites like cerebrospinal fluid (CSF) and lesion biopsies or extra-CNS sites like blood cultures, serology, tissue biopsies and respiratory samples. The management practices at centres that referred the cases were also evaluated. The rate of microbiological confirmation and outcomes in terms of mortality and disability by using 30th day Glasgow outcome scale (GOS) and duration of hospital stay were determined and compared between referred and non-referred group.
In this study out 88 cases with acute or subacute CNS infections, 50 were referred, and 38 were non-referred who presented directly. Non-referred cases had better microbiological confirmations (92.1% vs. 28%, p < 0.0001) and outcomes (GOS 4 or 5, 71% vs. 48%, p = 0.031) as compared to referred cases. The length of stay was also less in non-referred cases by an average of 8 days.
Earlier suspicion, appropriate sample collection and processing and prompt treatment improves outcome in cases with acute/subacute CNS infections. Better infrastructures and training are warranted at preliminary levels of health care, which usually are the first contact centre for such infections.
急性和亚急性中枢神经系统（CNS）感染是需要迅速且准确处理的严重医疗急症。在各级初级或二级医疗保健机构处理此类病例的做法，会对诊断和治疗结果产生影响，而患者通常首先在这些机构就诊并接受初步治疗。本研究旨在调查在三级医疗中心，转诊与未转诊的社区获得性中枢神经系统感染病例在微生物学确诊率和治疗结果方面的差异，同时找出首诊医疗机构管理实践中的差距。
本前瞻性研究在焦特布尔全印医学科学研究所（AIIMS）进行。所有疑似中枢神经系统感染的转诊和未转诊病例均接受微生物学评估，并通过利用来自中枢神经系统部位（如脑脊液（CSF）和病变活检）或中枢神经系统外部位（如血培养、血清学、组织活检和呼吸道样本）的标本，尽一切努力进行病因鉴定。还评估了转诊病例的医疗机构的管理做法。确定并比较了转诊组和未转诊组在微生物学确诊率、使用第30天格拉斯哥预后量表（GOS）评估的死亡率和残疾率以及住院时间方面的治疗结果。
在本研究的88例急性或亚急性中枢神经系统感染病例中，50例为转诊病例，38例为直接就诊的未转诊病例。与转诊病例相比，未转诊病例的微生物学确诊率更高（92.1%对28%，p<0.0001），治疗结果更好（GOS 4或5，71%对48%，p=0.031）。未转诊病例的住院时间也平均少8天。
早期怀疑、适当的样本采集和处理以及及时治疗可改善急性/亚急性中枢神经系统感染病例的治疗结果。在通常是此类感染首诊中心的初级医疗保健层面，需要更好的基础设施和培训。
