2025年3月10日出版的《柳叶刀》杂志发表了英国利物浦大学Tom Solomon研究组的最新成果，他们报道了改善巴西、印度和马拉维疑似急性脑感染住院患者的诊断和早期管理的多方面干预。

背景:脑感染在诊断和管理方面构成重大挑战，并具有高死亡率和发病率，特别是在低收入和中等收入国家。该研究组旨在改善巴西、印度和马拉维13家医院疑似急性脑感染的住院患者（16岁及以上的成年人和28天的儿童）的诊断和早期管理。

方法:该团队与医院利益相关者、政策制定者、患者和公众代表共同设计了一项多方面的临床和实验室干预措施，并对常规实践进行了评估。针对每种情况量身定制的干预措施包括诊断和管理算法、腰椎穿刺包、测试面板和工作人员培训。小组使用多变量逻辑回归和中断时间序列分析来比较主要结果——在干预前后获得综合征诊断的患者百分比和获得微生物诊断的百分比。

发现:在2021年1月5日至2022年11月30日期间，课题组筛选了10个在与巴西、印度和马拉维四个研究中心相连的13家医院，462名患者和总计2233名患者入组。干预前招募1376人（62%），干预后招募857人（38%）。2154例患者（96%）进行了主要结局评估（干预前招募1330例（62%）患者，干预后招募824例（38%）患者）。各中心的中位年龄为23岁（IQR 6-44），其中1276名（59%）为16岁或以上的成年人，888名（41%）为29天至15岁的儿童；男性1264例（59%），女性890例（41%）。种族和民族的数据没有记录。干预前1320例患者中有1020例（77%）得到综合征诊断，干预后813例患者中有701例（86%）得到综合征诊断(调整优势比[aOR] 1.81；术;0·0001)。干预前1330例患者中有294例（22%）进行了微生物诊断，干预后824例患者中有250例（30%）进行了微生物诊断(aOR为1.46；p = 0·00040)。中断时间序列分析证实，随着时间的推移，这些增长超过了适度改善的基本趋势。接受腰椎穿刺的百分比、适当治疗的时间和功能结果也有所改善。

研究结果表明，在三大洲不同类型的医院采用简单的一揽子干预措施后，疑似急性脑感染患者的诊断和管理得到了改善。作为世卫组织脑膜炎路线图和脑炎控制行动的一部分，目前正在其他环境中实施该干预措施。

附：英文原文

Title: A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: an international multicentre intervention study

Author: Bhagteshwar Singh, Gareth D Lipunga, Premkumar Thangavelu, Shalley Dhar, Lorena Ferreira Cronemberger, Kundavaram Paul Prabhakar Abhilash, Asha Mary Abraham, Carlos Alexandre Antunes de Brito, Maria Lúcia Brito Ferreira, Nagarathna Chandrashekar, Rui Duarte, Anna Fajardo Modol, Ben Chirag Ghale, Gagandeep Kang, Vykuntaraju K Gowda, Kevin Kuriakose, Suzannah Lant, Macpherson Mallewa, Emmie Mbale, Shona C Moore, Gloria Mwangalika, Prasanna B T Kamath, Patricia Navvuga, Alinane Linda Nyondo-Mipando, Tamara J Phiri, Camila Pimentel Lopes de Melo, B S Pradeep, Rebecca Rawlinson, Irene Sheha, Priya Treesa Thomas, Charles R Newton, Patricia Carvalho de Sequeira, James J Sejvar, Tarun Dua, Lance Turtle, Valsan Philip Verghese, Luciano Wagner de Melo Santiago Arraes, Nicola Desmond, Ava Easton, Jessica Anne Jones, Richard J Lilford, M Netravathi, Fiona McGill, Benedict D Michael, Victor Mwapasa, Michael J Griffiths, Christopher M Parry, Vasanthapuram Ravi, Girvan Burnside, Ajith Sivadasan, Reginald G Alex, Alex Shabani, Aline de Moura Brasil Matos, Anandhi Arumugam, Anbu Suresh Rao, André Silva Lira de Lucena, Angel Miraclin, Anitha Aswathanarayan, Anna Rosala-Hallas, Anna Simon, Anushri Somasundaran, Aparna Vasudev

Issue&Volume: 2025-03-10

Abstract: Background

Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi.

Methods

With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training. We used multivariable logistic regression and interrupted time series analysis to compare the coprimary outcomes—the percentage of patients achieving a syndromic diagnosis and the percentage achieving a microbiological diagnosis before and after the intervention. The study was registered at ClinicalTrials.gov (NCT04190303) and is complete.

Findings

Between Jan 5, 2021, and Nov 30, 2022, we screened 10462 patients and enrolled a total of 2233 patients at 13 hospital sites connected to the four study centres in Brazil, India, and Malawi. 1376 (62%) were recruited before the intervention and 857 (38%) were recruited after the intervention. 2154 patients (96%) had assessment of the primary outcome (1330 [62%] patients recruited pre-intervention and 824 [38%] recruited post-intervention). The median age across centres was 23 years (IQR 6–44), with 1276 (59%) being adults aged 16 years or older and 888 (41%) children aged between 29 days and 15 years; 1264 (59%) patients were male and 890 (41%) were female. Data on race and ethnicity were not recorded. 1020 (77%) of 1320 patients received a syndromic diagnosis before the intervention, rising to 701 (86%) of 813 after the intervention (adjusted odds ratio [aOR] 1·81 [95% CI 1·40–2·34]; p<0·0001). A microbiological diagnosis was made in 294 (22%) of 1330 patients pre-intervention, increasing to 250 (30%) of 824 patients post-intervention (aOR 1·46 [95% CI 1·18–1·79]; p=0·00040). Interrupted time series analysis confirmed that these increases exceeded a modest underlying trend of improvement over time. The percentage receiving a lumbar puncture, time to appropriate therapy, and functional outcome also improved.

Interpretation

Diagnosis and management of patients with suspected acute brain infections improved following introduction of a simple intervention package across a diverse range of hospitals on three continents. The intervention is now being implemented in other settings as part of the WHO Meningitis Roadmap and encephalitis control initiatives.

DOI: 10.1016/S0140-6736(25)00263-6

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00263-6/abstract