title: Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies.
abstract: The rapid diagnosis of an infectious cause in the course of fever of unknown origin plays a pivotal role in the correct management of neutropenic patients. In this study, blood samples from febrile oncohaematological patients were tested using a novel commercial real-time PCR assay (LightCycler SeptiFast; Roche Molecular Systems) and blood culture (BacT/Alert 3D; bioMérieux). Twenty-one (20.4 %) and 34 (33 %) of the 103 samples under study tested positive by blood culture and PCR, respectively. The analysis of concordance evidenced a low correlation between the two approaches (83 %), mainly due to samples that tested negative by culture but positive using the molecular approach. Among 14 discordant cases negative by culture but positive by PCR, 12 were observed in sequential samples of patients with initial concordant results on samples drawn before the administration of a specific antimicrobial therapy. Moreover, DNA of a fastidious organism, Aspergillus fumigatus, not easily detectable by the cultural approach was rapidly detected in the two remaining discordant cases. Overall, the characteristics featured by the molecular method could be of interest in the development of new algorithms for the diagnosis of sepsis in critical patients.
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Nicasio
authors.initials: N
authors.lastname: Mancini
authors.affiliation: Unità di Ematologia e Trapianto di Midollo Osseo, Istituto Scientifico San Raffaele, Milano, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Clerici
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Diotti
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Perotti
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ghidoli
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: De Marco
authors.affiliation: Roche Diagnostics S.p.A., Monza, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pizzorno
authors.affiliation: Roche Diagnostics GmbH, Molecular Diagnostics, Penzberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Emrich
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Burioni
authors.affiliation: Unità di Ematologia e Trapianto di Midollo Osseo, Istituto Scientifico San Raffaele, Milano, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Laboratorio di Microbiologia e Virologia, Università 'Vita-Salute' San Raffaele, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Clementi
mesh_terms: D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques; D015331:Cohort Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D016133:Polymerase Chain Reaction; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000175:diagnosis*