Potential clinical utility of polymerase chain reaction in microbiological testing for sepsis.
OBJECTIVE
To evaluate the potential improvement of antimicrobial treatment by utilizing a new multiplex polymerase chain reaction (PCR) assay that identifies sepsis-relevant microorganisms in blood.


METHODS
Prospective, observational international multicentered trial.


METHODS
University hospitals in Germany (n = 2), Spain (n = 1), and the United States (n = 1), and one Italian tertiary general hospital.


METHODS
436 sepsis patients with 467 episodes of antimicrobial treatment.


METHODS
Whole blood for PCR and blood culture (BC) analysis was sampled independently for each episode. The potential impact of reporting microorganisms by PCR on adequacy and timeliness of antimicrobial therapy was analyzed. The number of gainable days on early adequate antimicrobial treatment attributable to PCR findings was assessed.


RESULTS
Sepsis criteria, days on antimicrobial therapy, antimicrobial substances administered, and microorganisms identified by PCR and BC susceptibility tests.


RESULTS
BC diagnosed 117 clinically relevant microorganisms; PCR identified 154. Ninety-nine episodes were BC positive (BC+); 131 episodes were PCR positive (PCR+). Overall, 127.8 days of clinically inadequate empirical antibiotic treatment in the 99 BC+ episodes were observed. Utilization of PCR-aided diagnostics calculates to a potential reduction of 106.5 clinically inadequate treatment days. The ratio of gainable early adequate treatment days to number of PCR tests done is 22.8 days/100 tests overall (confidence interval 15-31) and 36.4 days/100 tests in the intensive care and surgical ward populations (confidence interval 22-51).


CONCLUSIONS
Rapid PCR identification of microorganisms may contribute to a reduction of early inadequate antibiotic treatment in sepsis.
Lehmann
Lutz Eric
LE
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany.
Alvarez
Julian
J
Hunfeld
Klaus-Peter
KP
Goglio
Antonio
A
Kost
Gerald J
GJ
Louie
Richard F
RF
Raglio
Annibale
A
Regueiro
Benito J
BJ
Wissing
Heimo
H
Stüber
Frank
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D055815:Young Adult
D000900:Anti-Bacterial Agents