Hristeva L, Bowler I, Booy R, King A, Wilkinson A R
John Radcliffe Hospital, Headington, Oxford.
Arch Dis Child. 1993 Nov;69(5 Spec No):514-7. doi: 10.1136/adc.69.5_spec_no.514.
Between 1 October 1988 and 30 September 1991 the results of all 896 cerebrospinal fluid examinations from 736 neonates were correlated with clinical diagnosis, treatment, and outcome. The prevalence of fungal or bacterial meningitis in babies requiring lumbar puncture was only 0.95%. Gram staining had a sensitivity of 68% and a positive predictive value of only 46% for the diagnosis of meningitis. Primary cultures directly onto agar plates had a sensitivity of 81% and positive predictive value of 46%. Broth enrichment cultures did not improve sensitivity and were frequently found to be false positive. Empirical treatment should not be altered unless more than a few organisms are seen on Gram staining. Primary cultures are adequate for the diagnosis of fungal and bacterial meningitis. Enrichment cultures should be performed only when the Gram stain and/or cell count suggests meningitis is likely. Clinicians should be aware that diagnostic tests performed in populations with a low prevalence of disease are likely to generate many false positive results and have a low positive predictive value.
在1988年10月1日至1991年9月30日期间，对736名新生儿的896次脑脊液检查结果与临床诊断、治疗及转归进行了相关性分析。需要进行腰椎穿刺的婴儿中真菌或细菌性脑膜炎的患病率仅为0.95%。革兰氏染色对脑膜炎诊断的敏感性为68%，阳性预测值仅为46%。直接接种于琼脂平板的原始培养物敏感性为81%，阳性预测值为46%。肉汤增菌培养并未提高敏感性，且经常出现假阳性结果。除非在革兰氏染色中发现多个病原体，否则不应改变经验性治疗方案。原始培养物足以诊断真菌和细菌性脑膜炎。仅当革兰氏染色和/或细胞计数提示可能为脑膜炎时才应进行增菌培养。临床医生应意识到，在疾病患病率较低的人群中进行诊断性检查可能会产生许多假阳性结果，且阳性预测值较低。
