Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

World Neurosurg. 2016 Jun 21;

Authors: Da R, Wu Y, Liu W, Shi H, Wang W

Abstract
OBJECTIVE: Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing post-operative central nervous system (CNS) infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty to differentiate infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis.
METHODS: Adult neurosurgical patients with CoNS who recovered via the use of CSF culture in BacT/ALERT Pediatric FAN blood culture bottles and were admitted from September 2013 to July 2015 were enrolled. The demographics, clinical and microbiological data, and treatment were reviewed, and the TTP of each culture was retrieved.
RESULTS: Thirty-nine adult patients with CoNS recovered from CSF culture were included. The TTP ranged from 7.68 to 57.36 hours (hrs). A univariate logistic regression analysis indicated patients with rapid TTP (<21.5 hrs) compared with those with longer TTP were more likely to be female, demonstrate an effective response to antibiotic therapy within 7 days, have clean-contaminated surgical incisions, and exhibit CSF leak. A multivariate logistic regression analysis indicated that being female, an effective antibiotic therapy within 7 days, and clean-contaminated surgical incisions were independent predictors of rapid TTP.
CONCLUSIONS: Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP would represent the pathogen of CNS infection rather than contamination in neurosurgical patients.

PMID: 27354293 [PubMed - as supplied by publisher]

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