Improved detection of blood stream pathogens by real-time PCR in severe sepsis.
OBJECTIVE
Evaluation of the technical and diagnostic feasibility of commercial multiplex real-time polymerase chain reaction (PCR) for detection of blood stream infections in a cohort of intensive care unit (ICU) patients with severe sepsis, performed in addition to conventional blood cultures.


METHODS
Dual-center cohort study.


METHODS
Surgical ICU of two university hospitals.


METHODS
One hundred eight critically ill patients fulfilling the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) severe sepsis criteria were included.


METHODS
None.


RESULTS
PCR results obtained in 453 blood samples from 108 patients were compared with corresponding blood culture results. PCR resulted in a twofold higher positivity rate when compared with conventional blood culture (BC) testing (114 versus 58 positive samples). In 40 out of 58 PCR positive assays the results of the corresponding blood cultures were identical to microorganisms detected by PCR. In 18 samples PCR and BC yielded discrepant results. Compared with conventional blood culture the sensitivity and specificity of PCR was 0.69 and 0.81, respectively. Further evaluation of PCR results against a constructed gold standard including conventional microbiological test results from other significant patient specimen (such as bronchio-alveolar lavage fluid, urine, swabs) and additionally generated clinical and laboratory information yielded sensitivity of 0.83 and specificity of 0.93.


CONCLUSIONS
Our cohort study demonstrates improved pathogen detection using PCR findings in addition to conventional blood culture testing. PCR testing provides increased sensitivity of blood stream infection. Studies addressing utility including therapeutic decision-making, outcome, and cost-benefit following diagnostic application of PCR tests are needed to further assess its value in the clinical setting.
Lehmann
Lutz Eric
LE
Klinik und Poliklinik für Anästhesie und Operative Intensivmedizin, Universitätsklinik Bonn, Sigmund-Freud-Str 25, 53105 Bonn, Germany. lutz.lehmann@ukb.uni-bonn.de
Hunfeld
Klaus-Peter
KP
Steinbrucker
Martina
M
Brade
Volker
V
Book
Malte
M
Seifert
Harald
H
Bingold
Tobias
T
Hoeft
Andreas
A
Wissing
Heimo
H
Stüber
Frank
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002116:Calcitonin / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000382:microbiology* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult
D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin