Detection of gram-negative bacteraemia in early sepsis by a quantitative chromogenic and kinetic endotoxin assay. The Study Group.
A kinetic chromogenic limulus test was carried out in order to investigate the possibility of a sensitive and specific detection of circulating endotoxin during the first 24 h of septic shock or severe sepsis in 76 patients. Two commercial kits, Whittaeker (W) and Chromogenix (C), were used. Blood culture was taken as a reference. At 1:10 plasma dilution (a currently used dilution in the end point limulus test) abnormal reaction kinetics were found in 13% and 41% of tests, for C and W respectively (P = 0.0008), resulting in unreliable results. Retesting plasma at a greater dilution, until the reaction kinetic was identical to calibration curve control values, gave similar results between the two kits and a better accuracy. Beyond a 0.5 EU mL-1 endotoxin level, the probability of Gram-negative bacteraemia was high (sensitivity = 0.53 and 0.47; specificity = 0.95 and 0.93 for C and W respectively). This kinetic limulus amoebocyte lysate (LAL) test may be useful in therapeutic decisions for treatment of endotoxaemia.
Massignon
D
D
Faculté de Médecine Lyon Nord, France.
Lepape
A
A
Debize
G
G
Remillieux
M F
MF
De Pasquale
V
V
Banssillon
V
V
Coeur
P
P
D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis*; D001431:Bacteriological Techniques / Q000706:statistics & numerical data; D002863:Chromogenic Compounds; D004731:Endotoxins / Q000032:analysis* / Q000097:blood; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007700:Kinetics; D008033:Limulus Test / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis
D002863:Chromogenic Compounds; D004731:Endotoxins