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Bögli SY, Wang SS, Pietrzko E, Müller A, Eisele A, Keller E, Brandi G. Plasma Inflammatory Markers and Ventriculostomy-Related Infection in Patients With Hemorrhagic Stroke: A Retrospective and Descriptive Study. Front Neurol 2022; 13:861435. [PMID: 35547383 PMCID: PMC9081843 DOI: 10.3389/fneur.2022.861435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Diagnosis of ventriculostomy-related infection (VRI) remains difficult due to the various existing definitions. In patients with hemorrhagic stroke, its diagnosis might be further complicated by the presence of intraventricular blood. Furthermore, hemorrhagic stroke per se may cause symptoms compatible with VRI. This study aimed to evaluate the benefit of plasma inflammatory markers for the diagnosis of VRI and its differentiation from patients with non-cerebral infection and patients without infection in a cohort of patients with hemorrhagic stroke. Methods A total of 329 patients with hemorrhagic stroke and an external ventricular drain (EVD) in situ were admitted to the Neurocritical Care Unit, University Hospital Zurich over a period of 6 years. Of those patients, 187 with subarachnoid hemorrhage and 76 with spontaneous intracerebral hemorrhage were included. Patients with VRI were compared to patients without any infection and to patients with non-cerebral infection, with regards to their clinical characteristics, as well as their inflammatory plasma and cerebrospinal fluid (CSF) markers. For the analysis, peak values were considered. Results The VRI was diagnosed in 36% of patients with subarachnoid and in 17% of patients with intracerebral hemorrhage. The VRI was diagnosed on an average day 9±6.2 after EVD insertion, one day after the white blood cell count (WBC) peaked in CSF (8 ± 6.3). Plasma inflammatory markers (WBC, C-reactive protein “CRP” and procalcitonin “PCT”) did not differ among patients with VRI compared to patients without infection. The CRP and PCT, however, were higher in patients with non-cerebral infection than in patients with VRI. The WBC in CSF was generally higher in patients with VRI compared to both patients without any infection and patients with non-cerebral infection. Conclusions No differences in plasma inflammatory markers could be found between patients with VRI and patients without any infection. Conversely, CRP/PCT were higher in patients with non-cerebral infection than in patients with VRI. Altogether, CRP, PCT, and WBC are not suitable parameters for VRI diagnosis in neurocritical care unit patients.
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Affiliation(s)
- Stefan Yu Bögli
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Department of Neurology, University Hospital Zürich, Zürich, Switzerland.,Clinical Neuroscience Center, University Hospital and University of Zürich, Zürich, Switzerland
| | - Sophie S Wang
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Elisabeth Pietrzko
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
| | - Achim Müller
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Amanda Eisele
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Clinical Neuroscience Center, University Hospital and University of Zürich, Zürich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Department of Neurosurgery and Institute for Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland.,Clinical Neuroscience Center, University Hospital and University of Zürich, Zürich, Switzerland
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Xiao Y, Shen X, Zhao QF, Yao YH, Yang TC, Niu JJ. Evaluation of Real-Time PCR Coupled With Multiplex Probe Melting Curve Analysis for Pathogen Detection in Patients With Suspected Bloodstream Infections. Front Cell Infect Microbiol 2019; 9:361. [PMID: 31696061 PMCID: PMC6817478 DOI: 10.3389/fcimb.2019.00361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/07/2019] [Indexed: 01/09/2023] Open
Abstract
Background: This study aimed to evaluate real-time polymerase chain reaction coupled with multiplex probe melting curve analysis (PCR-MCA) for pathogen detection in patients with suspected bloodstream infections (BSIs). Methods: A PCR-MCA assay was developed for simultaneous identification of 28 kinds of the most common pathogens and two resistance genes within a few hours. The diagnostic performance of the PCR-MCA assay was determined and compared to the results of blood culture. Results: A total of 2,844 consecutive new episodes of suspected BSIs in 2,763 patients were included in this study. There were 269 episodes of pathogens identified by blood culture. For all the pathogens tested, the PCR-MCA assay exhibited a sensitivity of 88.8% (239/269), specificity of 100% (2,575/2,575), and agreement of 98.9% (2,814/2,844). For the pathogens on the PCR-MCA list, the PCR-MCA results had a sensitivity of 99.2% (239/241), specificity of 100% (2,575/2,575), and agreement of 99.9% (2,814/2,816) compared with the results of blood culture. For seven samples with multiple pathogens identified simultaneously during one blood culture investigation, the PCR-MCA assay verified the results of the blood culture, with an agreement rate of 100% for each. Conclusion: The PCR-MCA assay could discover 88.8% of the pathogens in clinical practice, showing excellent diagnostic performance vs. that of blood culture for pathogen detection in patients with suspected BSIs, and would contribute to rapid diagnosis and correct antibiotic administration.
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Affiliation(s)
- Yao Xiao
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Xu Shen
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Qi-Feng Zhao
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Shaoxing Center for Disease Control and Prevention, Shaoxing, China
| | - Yi-Hui Yao
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tian-Ci Yang
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
| | - Jian-Jun Niu
- Center of Clinical Laboratory, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
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