title: Impact of multiplex PCR on antimicrobial treatment in febrile neutropenia: a randomized controlled study.
abstract: Multiplex PCR (mPCR) directly from blood has been suggested as a promising method for rapid identification of pathogens causing sepsis. This study aimed to investigate whether mPCR has any impact on antimicrobial treatment. Hematological patients with febrile neutropenia were randomized into two groups. In the study group, mPCR was performed as an addition to standard diagnostics, and PCR finding was immediately communicated to the clinicians, thus being available for decision making. In the control group, clinicians were not aware of PCR result. PCR samples were collected simultaneously with clinically indicated blood culture specimens from peripheral vein and/or central venous catheter at fever onset and once again if fever persisted up to 72 h. Overall, 74 patients of the study group and 76 patients of the control group were enrolled and 253 samples collected. Therapy was changed to targeted antimicrobial therapy (AMT) in 12 patients (16.2%) in the study group and in 12 patients (15.8%) in the control group. For patients with changes, the median time to change to the targeted AMT was 21.4 h in the study group and 47.5 h in the control group (p = 0.018). In the study group, 57.1% (8/14) of changes to targeted AMT was due to PCR finding. PCR led to AMT change in 9.5% (7/74) of study group patients, i.e., in 33.3% (7/21) of patients who had positive PCR finding. There were no significant differences in patient outcomes (secondary endpoints). In conclusion, PCR method accelerates change to the targeted AMT in febrile neutropenic patients.
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149, Mūnster, Germany.
authors.forename: Evgeny A
authors.initials: EA
authors.lastname: Idelevich
authors.forename: Gerda
authors.initials: G
authors.lastname: Silling
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Niederbracht
authors.forename: Hanna
authors.initials: H
authors.lastname: Penner
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Sauerland
authors.forename: Sascha
authors.initials: S
authors.lastname: Tafelski
authors.forename: Irit
authors.initials: I
authors.lastname: Nachtigall
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Georg
authors.initials: G
authors.lastname: Peters
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D064147:Febrile Neutropenia / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents