Cerebrospinal Fluid Presepsin As a Marker of Nosocomial Infections of the Central Nervous System: A Prospective Observational Study

Abstract

BackgroundNosocomial CNS infection (NI-CNS) is a common and serious complication in neurocritical care patients. Timely, accurate diagnosis of NI-CNS is crucial, yet current infection markers lack specificity and/or sensitivity. Presepsin (PSP) is a novel biomarker of macrophage activation. Its utility in NI-CNS has not been explored. We first determined the normal range of cerebrospinal fluid (CSF) PSP in a control group without brain injury before collecting data on CSF PSP levels in neurocritical care patients. Samples were analyzed in four groups defined by systemic and neurological infection status.ResultsCSF PSP levels in 15 control patients without neurological injury were 50–100 pg/ml. Ninety-seven CSF samples were collected from 21 neurocritical care patients. In patients without NI-CNS or systemic infection, CSF PSP was 340.4 ± 201.1 pg/ml. Isolated NI-CNS was associated with CSF PSP levels of 640.8 ± 235.5 pg/ml, while levels in systemic infection without NI-CNS were 580.1 ± 329.7 pg/ml. Patients with both NI-CNS and systemic infection had CSF PSP levels of 1,047.7 ± 166.2 pg/ml. In neurocritical care patients without systemic infection, a cut-off value of 321 pg/ml gives sensitivity and specificity for NI-CNS of 100 and 58.3%, respectively.ConclusionCSF PSP may prove useful in diagnosing NI-CNS, but its current utility is as an additional marker only.

Evaluation of the Diagnostic and Prognostic Value of CSF Presepsin Levels in Patients with Postneurosurgical Ventriculitis/Meningitis

“…Different articles have reported similar but not the same CSF presepsin concentrations in people. Abudeev reported that the range of presepsin levels in people without neurosurgery was 50–100 pg/mL, 15 while the study by Carpio reported a concentration of 153 pg/mL. 18 In our study, the presepsin level in patients without an infection after neurosurgery (rVM) was higher than that in people without neurosurgery.…”

“… 18 In our study, the presepsin level in patients without an infection after neurosurgery (rVM) was higher than that in people without neurosurgery. 15 The potential explanation is that the patient has an inflammatory response after surgical trauma. Compared with patients without surgery, macrophages secrete presepsin, resulting in an increase in the CSF concentration.…”

“…Plasma presepsin levels are significantly increased in patients with sepsis, and its concentration is directly proportional to the severity of sepsis, 14 with a high diagnostic sensitivity and specificity. At present, several studies have indicated that presepsin also exists in CSF 15 , 16 and can be applied in the diagnosis of children with bacterial meningitis, but its ability to differentially diagnose clinical cVM and pVM has not been reported. Therefore, this study first established a baseline presepsin level in the CSF of patients who underwent neurosurgery and evaluated the discriminative value in the diagnosis of cVM and pVM.…”

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: a retrospective Cross-Sectional Study

“…CSF should be acquired as soon as possible for analysis. (8)(9)(10)(11)(12)(13)(14)(15)(16) The most commonly found infectious pathogens are commensal organisms of the external auditory canal and nasopharynx in patients diagnosed with post-neurosurgical meningitis however the likelihood of nosocomial infection is recommended not to be overlooked. Aspiration of stomach contents is prevalent in individuals who have had a head injury, and it is typically worsened by bacterial super-infection.…”

Characteristics of Post-Neurosurgical Nosocomial Bacterial Meningitis in Adults: A retrospective Cross-Sectional Study

“…CSF should be acquired as soon as possible for analysis. (8)(9)(10)(11)(12)(13)(14)(15)(16) The most commonly found infectious pathogens are commensal organisms of the external auditory canal and nasopharynx in patients diagnosed with post-neurosurgical meningitis however the likelihood of nosocomial infection is recommended not to be overlooked. Aspiration of stomach contents is prevalent in individuals who have had a head injury, and it is typically worsened by bacterial superinfection.…”