title: Preliminary clinical study using a multiplex real-time PCR test for the detection of bacterial and fungal DNA directly in blood.
abstract: Early diagnosis of sepsis, rapid identification of the causative pathogen(s) and prompt initiation of appropriate antibiotic treatment have a combined impact on mortality due to sepsis. In this observational study, a new DNA-based system (LightCycler SeptiFast (LC-SF) test; Roche Diagnostics) allowing detection of 16 pathogens at the species level and four groups of pathogens at the genus level has been evaluated and compared with conventional blood cultures (BCs). One hundred BC and LC-SF results were obtained for 72 patients admitted to the intensive-care unit over a 6-month period for suspected sepsis. Microbiological data were compared with other biological parameters and with clinical data. The positivity rate of BCs for bacteraemia/fungaemia was 10%, whereas the LC-SF test allowed detection of DNA in 15% of cases. The LC-SF performance, based on its clinical relevance, was as follows: sensitivity, 78%; specificity, 99%; positive predictive value, 93%; and negative predictive value, 95%. Management was changed for four of eight (50%) of the patients because organisms were detected by the LC-SF test but not by BC. LC-SF results were obtained in 7-15 h, in contrast to the 24-72 h required for BC. According to the LC-SF results, initial therapy was inadequate in eight patients, and antibiotic treatment was changed. Our results suggest that the LC-SF test may be a valuable complementary tool in the management of patients with clinically suspected sepsis.
authors.affiliation: Pôle de Microbiologie, Centre Hospitalier Universitaire de Lille, Faculte de Medicine de Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: Wallet
authors.forename: S
authors.initials: S
authors.lastname: Nseir
authors.forename: L
authors.initials: L
authors.lastname: Baumann
authors.forename: S
authors.initials: S
authors.lastname: Herwegh
authors.forename: B
authors.initials: B
authors.lastname: Sendid
authors.forename: M
authors.initials: M
authors.lastname: Boulo
authors.forename: M
authors.initials: M
authors.lastname: Roussel-Delvallez
authors.forename: A V
authors.initials: AV
authors.lastname: Durocher
authors.forename: R J
authors.initials: RJ
authors.lastname: Courcol
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001769:Blood / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification*; D004271:DNA, Fungal / Q000235:genetics / Q000302:isolation & purification*; D042241:Early Diagnosis; D016469:Fungemia / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D008828:Microbiological Techniques / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D004269:DNA, Bacterial; D004271:DNA, Fungal