The utility of 16S rRNA gene sequencing on intraoperative specimens from intracranial infections: an 8-year study in a regional UK neurosurgical unit.
The utility of 16S rRNA gene sequencing on intraoperative specimens from intracranial infections: an 8-year study in a regional UK neurosurgical unit.
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16S rRNA 基因测序对颅内感染术中标本的效用：英国地区神经外科单位进行的一项为期 8 年的研究。
DOI：
10.1080/02688697.2021.2016620
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发表时间：
2021
影响因子：
1.1
通讯作者：
Shaw TD
中科院分区：
文献类型：
--
作者：
Shaw TD
颅内感染的最佳治疗依赖于微生物诊断和抗菌药物的选择，但传统的基于培养的检测受到病原体活力和预采样抗菌药物暴露的限制。广泛的16S rRNA基因测序已被报道用于治疗培养阴性感染，但其在颅内感染中的应用尚未得到充分描述。我们研究了16S rRNA基因测序的有效性，通知微生物学诊断和抗菌药物的选择在颅内infecties.MethodsThis是一项回顾性研究，所有术中神经外科标本发送16S rRNA基因测序超过8年的时间在英国的区域神经外科中心。标本选择进行多学科的方法，结合神经外科和感染specialisticdiscussion.Results25术中标本神经外科手术期间从24例被列入研究期间。转诊的最常见原因是采样前抗菌剂暴露（68%）。60%的标本中检测到细菌rDNA。16S rRNA基因测序有助于15例颅内感染患者的微生物学诊断，并为24例颅内感染患者中的10例提供了抗菌治疗信息。这些包括在检测到其他微生物检测未鉴定出的具有临床意义的病原体后使用靶向抗生素（3例），在神经外科感染中检测到颅内微生物，这证明继续广泛覆盖是合理的（2例），以及临床怀疑细菌感染的颅内病变的阴性结果，这证明避免或停止使用抗生素是合理的（5例）。16S rRNA基因测序代表了诊断检测的逐步改进，最适合用于补充而不是取代传统的颅内感染培养检测。
BackgroundOptimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections.MethodsThis was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion.ResultsTwenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases).ConclusionOverall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection.