Microscopic examination and broth culture of cerebrospinal fluid in diagnosis of meningitis
Microscopic examination and broth culture of cerebrospinal fluid in diagnosis of meningitis
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DOI：
10.1128/jcm.36.6.1617-1620.1998
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发表时间：
1998-06-01
影响因子：
9.4
通讯作者：
Clarridge, JE
中科院分区：
文献类型：
--
作者：
Dunbar, SA;Eason, RA;Clarridge, JE
我们回顾了55个月来在成人医院微生物实验室处理的2635例脑脊液（CSF）标本的显微镜革兰氏染色检查和常规培养结果，其中细菌性或真菌性脑膜炎56例（伴有中枢神经系统[CNS]分流感染16例），蛛网膜下腔附近感染4例，败血症4例，无脑膜炎。另外220份培养阳性的CSF标本中分离出的微生物被判定为污染物，因为这些污染物中有121种在肉汤中分离出来，因此消除肉汤培养可以减少不必要的工作。然而，25%与中枢神经系统分流术相关的脑膜炎会被这种做法遗漏。脑膜炎最常见的病因是新型隐球菌，其次是肺炎链球菌和脑膜炎奈瑟菌。56例病例中48例（88%）革兰氏染色标本检出病原菌。如果排除腰椎穿刺前接受过有效抗菌治疗的患者，脑脊液革兰氏染色的敏感性为92%。显微镜检查错误地提示2635例脑脊液检查中只有3例（0.1%）存在微生物。因此，显微镜检查革兰氏染色，浓缩脑脊液是高度敏感和特异性的早期诊断细菌性或真菌性脑膜炎。
We reviewed the results of microscopic Gram stain examination and routine culture for 2,635 cerebrospinal fluid (CSF) samples processed in an adult hospital microbiology laboratory during 55 months, There were 56 instances of bacterial or fungal meningitis (16 associated with central nervous system [CNS] shunt infection), four infections adjacent to the subarachnoid space, four cases of sepsis without meningitis, and an additional 220 CSF specimens with positive cultures in which the organism isolated was judged to be a contaminant, Because 121 of these contaminants were isolated in broth only, elimination of the broth culture would decrease unnecessary work. However, 25% of the meningitis associated with CNS shunts would have been missed by this practice. The most common cause of meningitis was Cryptococcus neoformans, followed by Streptococcus pneumoniae and Neisseria meningitidis., In 48 of 56 (88%) of cases, examination of the Gram-stained specimen revealed the causative organism. If patients who had received effective antimicrobial therapy prior to lumbar puncture are excluded, the CSF Gram stain is 92% sensitive. Microscopic examination incorrectly suggested the presence of organisms in only 3 of 2,635 (0.1%) CSF examinations. Thus, microscopic examination of Gram-stained, concentrated CSF is highly sensitive and specific in early diagnosis of bacterial or fungal meningitis.