Application Of NGS In Intracranial Infection After Neurosurgery In Children

Objective:1.To detect pathogens in the cerebrospinal fluid of children after craniotomy by NGS technology,and to comprehensively evaluate the application value of second-generation sequencing technology in pathogen identification after craniotomy in children with traditional culture methods.2.To evaluate the value of second-generation sequencing technology in the targeted antiinfection treatment of postoperative infection in children based on clinical manifestations and serological indicators.Methods:1.Subjects:Children admitted after neurosurgery in the Pediatric ICU of the Second Hospital of Hebei Medical University from December 2018 to December 2019.2.Diagnostic criteria:(1)the relevant clinical signs and symptoms caused by the exclusion of factors such as aseptic encephalitis,such as fever and other clinical manifestations such as changes in consciousness,headache,vomiting,pupil to light reflex,positive signs of the nervous system,etc;(2)CSF examination:CSF appearance is turbid,WBC>100*10~6L,and the percentage of multinuclear cells>70%;Or multinuclear cells absolute>30;With or without a decrease in glucose and increase in protein;(3)The bacterial culture of cerebrospinal fluid was positive.Those who meet the three criteria can be diagnosed as intracranial infection.If not,clinical diagnosis should be made by comprehensive consideration based on the examination indicators,clinical signs and symptoms of the patient;If the results of CSF examination are found to be critical,it needs to be perforated continuously for 2-3 days after surgery.If the number of CSF cells gradually decreases,it is determined to be caused by postoperative stress.3.Research Methods:2ml cerebrospinal fluid was collected and cryopreserved in vitro(-80℃),and then high-throughput sequencing was performed.Date analysis:Statistical analysis using SPSS26.0 software,count the“cases”and“rate”,said than chidren with postoperative craniotomy through detecting the positive rate of NGS technology and traditional CSF cultures positive for paired samples of Pearson X Test or Fisher’s exact rate test,P<0.05 was considered statistically significant.Results:1.Among the 27 children after craniotomy,2 had positive cerebrospinal fluid culture,carbapenem-resistant Acinetobacter baumannii(CRAB)and human staphylococcus subspecies(Mscons);The cerebrospinal fluid(CSF)of 27children was detected by NGS,and 17 of them were found to be positive after the background sequence was excluded.2.The positive rate of NGS test was higher than that of traditional culture when the clinical manifestations and CSF routine biochemical data were diagnosed as the diagnostic criteria.The results of cerebrospinal fluid(CSF)in27 children after craniotomy were compared with those of traditional etiology(P=0.535>0.05)by Fisher’s exact rate test,and the difference was not statistically significant.Therefore,it could not be considered that the positive rates of the two methods were different.Conclusion:1.Due to the small sample size,it is not considered that the application of NGS technology can improve the positive rate of intracranial infection pathogens after craniotomy.2.NGS technology can detect a variety of pathogens at one time,and can provide diagnostic ideas for some infections whose etiologu is unknown.