title: Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis - a systemic review and meta-analysis.
abstract: BACKGROUND
  Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.
  
  
  METHODS
  Related literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.
  
  
  RESULTS
  A total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65-0·83) and 0·92 (95%CI:0·90-0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70-0·88) and a specificity of 0·95(95%CI: 0·93-0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48-0·72) and a specificity of 0·99 (95%CI: 0·99-0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.
  
  
  CONCLUSIONS
  LC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.
authors.affiliation: Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Wen-Han
authors.initials: WH
authors.lastname: Hsieh
authors.forename: Ting-Shou
authors.initials: TS
authors.lastname: Liu
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Wang
authors.forename: Hao-Chang
authors.initials: HC
authors.lastname: Chou
authors.forename: Yee Hui
authors.initials: YH
authors.lastname: Yeo
authors.forename: Ching-Ping
authors.initials: CP
authors.lastname: Tseng
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000235:genetics; D004271:DNA, Fungal / Q000235:genetics; D016469:Fungemia / Q000175:diagnosis / Q000382:microbiology*; D005658:Fungi / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D004269:DNA, Bacterial; D004271:DNA, Fungal