title: Diagnostic accuracy of presepsin (sCD14-ST) for prediction of bacterial infection in cerebrospinal fluid samples from children with suspected bacterial meningitis or ventriculitis.
abstract: Children with temporary external ventricular drains (EVD) are prone to nosocomial infections. Diagnosis of bacterial meningitis and ventriculitis in these children is challenging due to frequent blood contamination of cerebrospinal fluid (CSF) and the presence of chemical ventriculitis. The aim of this study was to compare diagnostic accuracy of presepsin (sCD14-ST), a novel biomarker of bacterial infection in CSF, to predict bacterial infection in comparison to the accuracy of established biomarkers like those demonstrated in biochemical analysis of CSF. We conducted a prospective study with 18 children with suspected bacterial meningitis or ventriculitis who had 66 episodes of disease. CSF samples were taken from external ventricular drainage. We measured presepsin in CSF, as well as CSF leukocyte count, glucose, and proteins. CSF was also taken to prove bacterial infection with culture methods or with 16S rRNA gene broad-range PCR (SepsiTest; Molzym, Germany). Infection was clinically confirmed in 57 (86%) episodes of suspected meningitis or ventriculitis. Chemical ventriculitis was diagnosed in 9 (14%) episodes of suspected meningitis or ventriculitis. Diagnostic accuracies presented as area under the curve (AUC) for sCD14-ST, leukocytes, and proteins measured in CSF were 0.877 (95% confidence interval [CI], 0.793 to 0.961), 0.798 (95% CI, 0.677 to 0.920), and 0.857 (95% CI, 0.749 to 0.964), respectively. With CSF culture, we detected bacteria in 17 samples, compared to 37 detected with broad-range PCR. It was found that presepsin was present at a significantly higher level in children with clinically proven ventriculitis than in those without meningitis or ventriculitis. Diagnostic accuracies of presepsin were superior to those of leukocytes or proteins in CSF. Presepsin-guided 16S rRNA gene PCR could be used in everyday clinical practice to improve etiological diagnosis of meningitis and ventriculitis and to prescribe more appropriate antibiotics.
authors: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors: David
authors: D
authors: Stubljar
authors: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors: Andreja Natasa
authors: AN
authors: Kopitar
authors: Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors: Mojca
authors: M
authors: Groselj-Grenc
authors: Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors: Kristina
authors: K
authors: Suhadolc
authors: Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors: Teja
authors: T
authors: Fabjan
authors: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia miha.skvarc@mf.uni-lj.si.
authors: Miha
authors: M
authors: Skvarc
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D058565:Cerebral Ventriculitis / Q000175:diagnosis* / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000737:chemistry*; D002648:Child; D002675:Child, Preschool; D004275:DNA, Ribosomal / Q000235:genetics; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D018950:Lipopolysaccharide Receptors / Q000134:cerebrospinal fluid*; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000473:pathology; D010446:Peptide Fragments / Q000134:cerebrospinal fluid*; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics
chemical_list: D015415:Biomarkers; D004275:DNA, Ribosomal; D018950:Lipopolysaccharide Receptors; D010446:Peptide Fragments; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; C000594167:presepsin protein, human
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