Impact of round-the-clock CSF Gram stain on empirical therapy for suspected central nervous system infections.

Détails

ID Serval
serval:BIB_319F544687D0
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of round-the-clock CSF Gram stain on empirical therapy for suspected central nervous system infections.
Périodique
European Journal of Clinical Microbiology and Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
Auteur(s)
Tissot F., Prod'hom G., Manuel O., Greub G.
ISSN
1435-4373 (Electronic)
ISSN-L
0934-9723
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
34
Numéro
9
Pages
1849-1857
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
The impact of round-the-clock cerebrospinal fluid (CSF) Gram stain on overnight empirical therapy for suspected central nervous system (CNS) infections was investigated. All consecutive overnight CSF Gram stains between 2006 and 2011 were included. The impact of a positive or a negative test on empirical therapy was evaluated and compared to other clinical and biological indications based on institutional guidelines. Bacterial CNS infection was documented in 51/241 suspected cases. Overnight CSF Gram stain was positive in 24/51. Upon validation, there were two false-positive and one false-negative results. The sensitivity and specificity were 41 and 99 %, respectively. All patients but one had other indications for empirical therapy than Gram stain alone. Upon obtaining the Gram result, empirical therapy was modified in 7/24, including the addition of an appropriate agent (1), addition of unnecessary agents (3) and simplification of unnecessary combination therapy (3/11). Among 74 cases with a negative CSF Gram stain and without formal indication for empirical therapy, antibiotics were withheld in only 29. Round-the-clock CSF Gram stain had a low impact on overnight empirical therapy for suspected CNS infections and was associated with several misinterpretation errors. Clinicians showed little confidence in CSF direct examination for simplifying or withholding therapy before definite microbiological results.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents/therapeutic use, Cerebrospinal Fluid/microbiology, Child, Child, Preschool, Community-Acquired Infections/diagnosis, Community-Acquired Infections/microbiology, Cross Infection/diagnosis, Cross Infection/microbiology, Female, Gentian Violet, Humans, Infant, Infant, Newborn, Male, Meningitis, Bacterial/diagnosis, Meningitis, Bacterial/drug therapy, Middle Aged, Phenazines, Polymerase Chain Reaction, Retrospective Studies, Sensitivity and Specificity, Staining and Labeling/methods, Tertiary Care Centers, Young Adult
Pubmed
Web of science
Création de la notice
22/09/2015 16:27
Dernière modification de la notice
20/08/2019 13:17
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