title: Rapid diagnosis of bloodstream infections with PCR followed by mass spectrometry.
abstract: Achieving a rapid microbiological diagnosis is crucial for decreasing morbidity and mortality of patients with a bloodstream infection, as it leads to the administration of an appropriate empiric antimicrobial therapy. Molecular methods may offer a rapid alternative to conventional microbiological diagnosis involving blood culture. In this study, the performance of a new technology that uses broad-spectrum PCR coupled with mass spectrometry (PCR/ESI-MS) was evaluated for the detection of microorganisms directly from whole blood. A total of 247 whole blood samples and paired blood cultures were prospectively obtained from 175 patients with a suspicion of sepsis. Both sample types were analyzed using the PCR/ESI-MS technology, and the results were compared with those obtained by conventional identification methods. The overall agreement between conventional methods and PCR/ESI-MS performed in blood culture aliquots was 94.2% with 96.8% sensitivity and 98.5% specificity for the molecular method. When comparing conventional methods with PCR/ESI-MS performed in whole blood specimens, the overall agreement was 77.1% with 50% sensitivity and 93.8% specificity for the molecular method. Interestingly, the PCR/ESI-MS technology led to the additional identification of 13 pathogens that were not found by conventional methods. Using the PCR/ESI-MS technology the microbiological diagnosis of bloodstream infections could be anticipated in about half of the patients in our setting, including a small but significant proportion of patients newly diagnosed. Thus, this promising technology could be very useful for the rapid diagnosis of sepsis in combination with traditional methods.
authors.affiliation: Microbiology Department, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Jordana-Lluch
authors.forename: Heather E
authors.initials: HE
authors.lastname: Carolan
authors.forename: Montserrat
authors.initials: M
authors.lastname: Giménez
authors.forename: Rangarajan
authors.initials: R
authors.lastname: Sampath
authors.forename: David J
authors.initials: DJ
authors.lastname: Ecker
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Quesada
authors.forename: Josep M
authors.initials: JM
authors.lastname: Mòdol
authors.forename: Fernando
authors.initials: F
authors.lastname: Arméstar
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Blyn
authors.forename: Lendell L
authors.initials: LL
authors.lastname: Cummins
authors.forename: Vicente
authors.initials: V
authors.lastname: Ausina
authors.forename: Elisa
authors.initials: E
authors.lastname: Martró
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D008828:Microbiological Techniques; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult