A multicenter trial to compare blood culture  with polymerase chain reaction in severe  human sepsis.
OBJECTIVE
To assess the presence of microbial DNA in the blood by polymerase chain reaction (PCR) and its association with disease severity and markers of inflammation in severe sepsis and to compare the performance of PCR with blood culture (BC).


METHODS
Prospective multicentric controlled observational study.


METHODS
Three surgical intensive care units in university centers and large teaching hospitals.


METHODS
One hundred forty-two patients with severe sepsis and 63 surgical controls.


METHODS
Presence of microbial DNA was assessed by multiplex PCR upon enrollment, and each time a BC was obtained.


RESULTS
Controls had both approximately 4% positive PCRs and BCs. In severe sepsis, 34.7% of PCRs were positive compared to 16.5% of BCs (P < 0.001). Consistently, 70.3% of BCs had a corresponding PCR result, while only 21.4% of PCR results were confirmed by BC. Compared to patients with negative PCRs at enrollment, those testing positive had higher organ dysfunction scores [SOFA, median (25th-75th percentile) 12 (7-15) vs. 9 (7-11); P = 0.023] and a trend toward higher mortality (PCR negative 25.3%; PCR positive 39.1%; P = 0.115).


CONCLUSIONS
In septic patients, concordance between BC and PCR is moderate. However, PCR-based pathogen detection correlated with disease severity even if the BC remained negative, suggesting that presence of microbial DNA in the bloodstream is a significant event. The clinical utility to facilitate treatment decisions warrants investigation.
Bloos
Frank
F
Department of Anesthesiology and Intensive Care Therapy, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany. frank.bloos@med.uni-jena.de
Hinder
Frank
F
Becker
Karsten
K
Sachse
Svea
S
Mekontso Dessap
Armand
A
Straube
Eberhard
E
Cattoir
Vincent
V
Brun-Buisson
Christian
C
Reinhart
Konrad
K
Peters
Georg
G
Bauer
Michael
M
D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000235:genetics* / Q000382:microbiology; D012720:Severity of Illness Index
D004279:DNA, Viral