title: Beyond Blood Culture and Gram Stain Analysis: A Review of Molecular Techniques for the Early Detection of Bacteremia in Surgical Patients.
abstract: BACKGROUND
  Sepsis from bacteremia occurs in 250,000 cases annually in the United States, has a mortality rate as high as 60%, and is associated with a poorer prognosis than localized infection. Because of these high figures, empiric antibiotic administration for patients with systemic inflammatory response syndrome (SIRS) and suspected infection is the second most common indication for antibiotic administration in intensive care units (ICU)s. However, overuse of empiric antibiotics contributes to the development of opportunistic infections, antibiotic resistance, and the increase in multi-drug-resistant bacterial strains. The current method of diagnosing and ruling out bacteremia is via blood culture (BC) and Gram stain (GS) analysis.
  
  
  METHODS
  Conventional and molecular methods for diagnosing bacteremia were reviewed and compared. The clinical implications, use, and current clinical trials of polymerase chain reaction (PCR)-based methods to detect bacterial pathogens in the blood stream were detailed.
  
  
  RESULTS
  BC/GS has several disadvantages. These include: some bacteria do not grow in culture media; others do not GS appropriately; and cultures can require up to 5 d to guide or discontinue antibiotic treatment. PCR-based methods can be potentially applied to detect rapidly, accurately, and directly microbes in human blood samples.
  
  
  CONCLUSIONS
  Compared with the conventional BC/GS, particular advantages to molecular methods (specifically, PCR-based methods) include faster results, leading to possible improved antibiotic stewardship when bacteremia is not present.
authors.affiliation: 1 The Center for Translational Injury Research (CeTIR) , Department of Surgery, University of Texas Health Science Center , Houston, Texas.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Scerbo
authors.affiliation: 2 Department of Microbiology and Molecular Genetics, University of Texas Health Science Center , Houston, Texas.
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Kaplan
authors.affiliation: 4 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: 2 Department of Microbiology and Molecular Genetics, University of Texas Health Science Center , Houston, Texas.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Litwin
authors.affiliation: 3 Department of Orthopedic Surgery, University of Texas Health Science Center , Houston, Texas.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Ambrose
authors.affiliation: 1 The Center for Translational Injury Research (CeTIR) , Department of Surgery, University of Texas Health Science Center , Houston, Texas.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Moore
authors.affiliation: 5 Department of Medicine, Infectious Disease Service, Brooke Army Medical Center , Fort Sam Houston, Texas.
authors.forename: Col Clinton K
authors.initials: CC
authors.lastname: Murray
authors.affiliation: 1 The Center for Translational Injury Research (CeTIR) , Department of Surgery, University of Texas Health Science Center , Houston, Texas.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: 1 The Center for Translational Injury Research (CeTIR) , Department of Surgery, University of Texas Health Science Center , Houston, Texas.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D000071997:Blood Culture; D005840:Gentian Violet; D006801:Humans; D058889:Molecular Typing / Q000379:methods*; D010619:Phenazines; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013194:Staining and Labeling / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet