title: Direct molecular detection of pathogens in blood as specific rule-in diagnostic biomarker in patients with presumed sepsis: our experience on a heterogeneous cohort of patients with signs of infective systemic inflammatory response syndrome.
abstract: The practical value of blood cultures in the diagnosis of sepsis is impaired by a delay in the turnaround time to result and by the fact that blood culture positive can be found for only about 30% of these patients. Conventional laboratory signs of sepsis and acute phase protein biomarkers are sensitive and easy to use, but often also very nonspecific. Molecular diagnostic reflects currently the most promising avenue to decrease time to result and to influence decision making for antibiotic therapy in the septic host. In this study, we wish to highlight the impact of the LightCycler SeptiFast, a multipathogen probe-based real-time polymerase chain reaction, in the rapid etiological diagnosis of sepsis in patients with clinical and laboratory signs of bloodstream infections. We have evaluated prospectively 830 adult patients with suspected bloodstream infection and at least two criteria of systemic inflammatory response syndrome. In more than 50% of critically ill patients strongly suspected of having sepsis, we arrived to an etiological diagnosis only by the molecular method in a median time of 15 h, with specificity and predictive positive values of 96% and 94%, respectively. We highlight the role of DNAemia as time-critical, high-specificity, etiological, non-culture-based rule-in diagnostic biomarker in patients with presumed sepsis.
authors.affiliation: Department of Clinical Microbiology and Virology, S. Maria Degli Angeli Regional Hospital, Pordenone, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Avolio
authors.forename: Paola
authors.initials: P
authors.lastname: Diamante
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Modolo
authors.forename: Rita
authors.initials: R
authors.lastname: De Rosa
authors.forename: Paola
authors.initials: P
authors.lastname: Stano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Camporese
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis; D001800:Blood Specimen Collection / Q000379:methods; D004269:DNA, Bacterial / Q000097:blood*; D004271:DNA, Fungal / Q000097:blood*; D016469:Fungemia / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000150:complications / Q000175:diagnosis*; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial; D004271:DNA, Fungal