瑞典神经外科重症监护病房医院感染快速筛查试验的试点评估

A. Ramezani, Roya Darbani, Lars Eng, J. Lönn, Lan Yin, F. Nayeri, A. Theodorsson
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引用次数: 1

摘要

补充的数字内容可在文本中找到。背景当神经外科术后患者出现发热时,没有方便的方法可以立即指示感染部位。与呼吸机相关性肺炎或尿路感染相比,医院性脑膜炎的经验性抗生素治疗的选择明显不同。由于抗生素预防,传统的细菌培养存在假阴性的风险,对此类患者的脑脊液(CSF)进行直接显微镜分析的诊断价值有限。由于院内脑膜炎的死亡率很高,因此通常采用大剂量广谱抗生素。中性粒细胞作为先天免疫系统的一部分,通过中性粒细胞胞外陷阱(NETs)诱捕和杀死细菌。中性粒细胞胞外陷阱由胞外DNA组成,在细菌性脑膜炎期间释放到脑脊液。利用硫酸盐-氨基葡萄糖聚糖和苯胺染料的组合,开发了一种测量方法,该方法与细胞外宿主DNA发生反应,并在1分钟内根据被测体液中NETs的数量成比例地改变颜色。本研究旨在评价“快速NETs试验”识别感染部位的敏感性和特异性。方法对在神经外科重症监护病房常规采集的脑脊液剩余标本199例进行分析。患者转至病房后未纳入样本。发热患者除采集脑脊液外,还采集支气管肺泡液和尿液样本。采用“快速NETs试验”对新鲜剩余样品进行同步分析。最终诊断在出院时确定。结果75例(64%)患者接受了经验性抗生素治疗,其中仅有19例(16%)确诊。快速NETs试验可鉴别确诊的脑膜炎(n = 19),敏感性为89.5%,特异性为92.5%。该试验还发现呼吸机相关性肺炎(n = 32),敏感性为93.8%,特异性为86.8%。然而,该检测在诊断院内尿路感染方面并不可靠(敏感性为78.6%,特异性为55.2%)。结论神经外科术后发热患者感染部位的快速NETs检测具有临床相关的敏感性和特异性,有可能减少抗生素的不必要使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Pilot Evaluation of a Rapid Screening Test for Nosocomial Infection at a Neurosurgical Intensive Care Unit in Sweden
Supplemental digital content is available in the text. Background When postneurosurgery patients develop fever, there are no convenient methods to immediately indicate the site of infection. The choice of empirical antibiotic therapy is evidently different in nosocomial meningitis compared with ventilator-associated pneumonia or urinary tract infection. Conventional bacterial cultures run a risk of being false negative due to antibiotic prophylaxis, and direct microscopic analysis of cerebrospinal fluid (CSF) from such patients has limited diagnostic value. Because of the substantial mortality associated with nosocomial meningitis, broad spectrum antibiotics in high dosage are, therefore, commonly administered. Neutrophils as a part of the innate immunity system, trap and kill bacteria by neutrophil extracellular traps (NETs). Neutrophil extracellular traps are composed of extracellular DNA which is released to the CSF during bacterial meningitis. Using a combination of sulphated-glucosaminoglycan and aniline dyes, a measurement method was developed that reacts to extracellular host DNA and changes color within 1 minute in proportion to the amount of NETs in the body fluid tested. The present study aimed to evaluate the sensitivity and specificity of the “rapid NETs test” in identifying the site of infection. Methods We performed analysis on the left-over CSF samples (n = 199) that were collected routinely at neurosurgical intensive care unit. No samples were included after patients were transferred to the ward. Besides CSF, bronchoalveolar fluid, and urine samples were collected in febrile patients. The “rapid NETs test” was used for simultaneous analysis of the fresh left-over samples. The final diagnosis was settled at discharge. Results A total of 75 (64%) patients had received empirical antibiotic therapy against nosocomial meningitis, whereas only 19 patients of these cases (16%) had a verified diagnosis. The rapid NETs test could distinguish a verified meningitis (n = 19) with 89.5% sensitivity and 92.5% specificity. The test also identified ventilator-associated pneumonia (n = 32) with 93.8% sensitivity and 86.8% specificity. However, the test was not reliable in identifying nosocomial urinary tract infection (sensitivity and specificity, 78.6% and 55.2%, respectively). Conclusions The rapid NETs test indicated the site of infection in febrile patients postneurosurgery with clinically relevant sensitivity and specificity, which might show its potential to minimize the unnecessary use of antibiotics.
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