title: Diagnostic value of PCR analysis of bacteria and fungi from blood in empiric-therapy-resistant febrile neutropenia.
abstract: This study aimed to assess the clinical utility of PCR for the analysis of bacteria and fungi from blood for the management of febrile neutropenic patients with hematologic malignancies. Using a PCR system able to detect a broad range of bacteria and fungi, we conducted a prospective pilot study of periodic analyses of blood from patients following intensive chemotherapy. When fever occurred, it was treated with empirical antibiotic therapy, basically without knowledge of the PCR results. In 23 febrile episodes during the neutropenic period, bacteria were detected by PCR in 11 cases, while the same species were identified by blood culture in 3 cases. In 10 out of 11 PCR-positive cases, fever could be managed by empirical therapy. In the empirical-therapy-resistant case, the identification of Stenotrophomonas maltophilia by PCR led to improvement of fever. No fungi were detected by PCR in febrile cases, while Aspergillus fumigatus was detected in one afebrile patient, several days before a clinical diagnosis was made. In subsequent sporadic PCR analyses in 15 cases of febrile neutropenia, bacteria were detected by both PCR and blood culture in 7 cases and by PCR alone in 6. Fungi were not detected. While fever was improved by empirical therapy in 12 out of the 13 PCR-positive cases, the identification of Pseudomonas aeruginosa by PCR in one therapy-resistant case contributed to the successful treatment of persistent fever. Our results indicate that PCR analysis of bacteria from blood provides essential information for managing empirical-therapy-resistant febrile neutropenia.
authors.affiliation: Central Clinical Laboratories, Mie University Hospital, Mie, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Nakamura
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sugimoto
authors.forename: Kohshi
authors.initials: K
authors.lastname: Ohishi
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujieda
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Monma
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Masuya
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nakase
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsushima
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Katayama
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nobori
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001769:Blood / Q000382:microbiology*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D005658:Fungi / Q000235:genetics / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology; D009503:Neutropenia / Q000139:chemically induced / Q000276:immunology*; D016133:Polymerase Chain Reaction / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents
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