脑脊液宏基因组二代测序在小儿神经外科术后颅内细菌感染诊断中的应用

Application of cerebrospinal fluid metagenomic next-generation sequencing in the diagnosis of intracranial bacterial infection after pediatric neurosurgery

摘要:

目的 探讨脑脊液宏基因组二代测序(mNGS)技术在小儿神经外科术后颅内细菌感染诊断中的应用。 方法 分析2020年1月1日—2023年8月31日在中南大学某医院儿童重症监护病房住院的神经外科手术后符合颅内细菌感染诊断标准(包括临床诊断及确诊)病例的临床资料, 2021年10月起, 在经验性使用抗颅内感染药物前送检脑脊液培养和mNGS检测。对脑脊液mNGS结果阴性病例, 结合脑脊液培养结果及临床资料, 不进行或尽早停用经验性抗颅内感染治疗并追踪随访。 结果 共纳入43例病例, 其中临床诊断组38例, 病原学诊断组5例。脑脊液常规及生化指标两组间比较, 差异均无统计学意义(均P＞0.05)。临床诊断组38例病例中, 2020年1月—2021年9月10例临床诊断病例(对照组), 临床诊断颅内感染后接受经验性抗菌药物治疗; 2021年10月—2023年8月28例临床诊断颅内感染病例(干预组)mNGS病原学和脑脊液培养均阴性, 16例病例未进行经验性抗颅内感染治疗, 另12例在mNGS回报阴性后结合临床资料及时停止经验性抗颅内感染治疗, 追踪随访28例病例均无细菌性脑膜炎发生, 入颅抗菌药物平均使用时间[0(0, 4) d]低于对照组10例临床诊断病例抗菌药物平均使用时间[8(7, 11) d, P＜0.05]。 结论 脑脊液mNGS可以提高神经外科术后颅内细菌感染病例病原学检出率, mNGS检测结果有助于指导神经外科术后颅内细菌感染临床诊断病例抗菌药物的合理使用。

Abstract:

Objective To investigate the application of cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) in the diagnosis of intracranial bacterial infection after pediatric neurosurgery. Methods Clinical data of patients who met the diagnostic criteria for intracranial bacterial infection (including clinical diagnosis and confirmed diagnosis) after neurosurgery in the pediatric intensive care unit of a hospital of Central South University from January 1, 2020 to August 31, 2023 were analyzed. From October 2021, CSF culture and mNGS detection were performed before empirical use of anti-intracranial infection agents, for patients with negative mNGS results of CSF, combined with CSF culture results and clinical data, the empirical anti-intracranial infection treatment was not given or stopped as early as possible, and follow-up was conducted. Results A total of 43 children were included in the analysis, including 38 cases in clinical diagnosis group and 5 cases in pathogen diagnosis group. There were no statistically significant differences in routine and biochemical indicators of CSF detection between the two groups (both P>0.05). Among 38 cases in the clinical diagnosis group, 10 clinically diagnosed cases (control group) received empirical antimicrobial treatment after clinically diagnosed intracranial infection from January 2020 to September 2021; 28 clinically diagnosed cases of intracranial infection had negative results of mNGS pathogen and cerebrospinal fluid culture from October 2021 to August 2023 (intervention group). Sixteen cases didn't receive empirical anti-intracranial infection treatment, and the other 12 cases stopped the empirical anti-intracranial infection treatment in time after the reporting of negative mNGS and combining with clinical data. No bacterial meningitis occurred among the 28 cases during the followed-up, and the average duration (0[0, 4] days) of intracranial antimicrobial use was shorter than that of the 10 clinically diagnosed cases in the control group (8[7, 11] days, P < 0.05). Conclusion CSF mNGS can improve the pathogen detection rate of intracranial bacterial infection after neurosurgery, and the detection result of mNGS can help guide the rational use of antimicrobial agents in the clinically diagnosed intracranial bacterial infection after neurosurgery.