title: Prospective evaluation of SeptiFast Multiplex PCR in children with systemic inflammatory response syndrome under antibiotic treatment.
abstract: BACKGROUND
  Antimicrobially pre-treated children with systemic inflammation often pose a diagnostic challenge to the physician. We aimed to evaluate the additional use of SeptiFast multiplex polymerase chain reaction (PCR) to identify causative pathogens in children with suspected systemic bacterial or fungal infection.
  
  
  METHODS
  Prospective observational study in 39 children with systemic inflammatory response syndrome (SIRS) under empiric antibiotic treatment. Primary outcome was the rate of positive blood cultures (BC), compared to the rate of positive SeptiFast (SF) results.
  
  
  RESULTS
  In total, 14 SF-samples yielded positive results, compared to 4 positive BC (p < 0.05). All blood cultures and 13 of 14 positive SF-tests were considered infection. Median time for positive BC was 2 days, and time to definite result was 6 days, compared to 12 h for SF. Antimicrobial therapy was adapted in 7 of the 14 patients with positive SeptiFast, and in 3 of the 4 patients with positive BC. Best predictive power for positive SF shown by receiver-operating characteristic was demonstrated for procalcitonin PCT (Area under the curve AUC: 0.79), compared to C-reactive protein CRP (AUC: 0.51) and leukocyte count (AUC: 0.46). A procalcitonin threshold of 0.89 ng/ml yielded a sensitivity of 0.82 and a specifity of 0.7. Children with a positive SeptiFast result on day 0 had a significantly higher risk to require treatment on the Pediatric Intensive Care Unit or to be deceased on day 30 (Odds-Ratio 8.62 (CI 1.44-51.72).
  
  
  CONCLUSIONS
  The additional testing with SeptiFast in antimicrobially pre-treated children with systemic inflammation enhances the rate of pathogen detection. The influence of multiplex PCR on clinically relevant outcome parameters has to be further evaluated. (
  
  
  BACKGROUND
  DRKS00004694).
authors: Department of Pediatrics I, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors: Franziska
authors: F
authors: Gies
authors: Department of Pediatrics I, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors: Eva
authors: E
authors: Tschiedel
authors: Department of Pediatrics I, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors: Ursula
authors: U
authors: Felderhoff-Müser
authors: Institute of Medical Microbiology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors: Peter-Michael
authors: PM
authors: Rath
authors: Institute of Medical Microbiology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
authors: Joerg
authors: J
authors: Steinmann
authors: Department of Pediatrics I, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. christian.dohna-schwake@uk-essen.de.|Centre Hospitalier Universitaire Bicêtre, Réanimation Pédiatrique et Médecine Néonatale, Hôpitaux Universitaires Paris-Sud AP-HP, 78, Rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France. christian.dohna-schwake@uk-essen.de.
authors: Christian
authors: http://orcid.org/0000-0001-8973-5406
authors: C
authors: Dohna-Schwake
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019540:Area Under Curve; D001232:Aspergillus fumigatus / Q000235:genetics; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D002175:Candida / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D016983:Enterococcus / Q000235:genetics; D004926:Escherichia coli / Q000235:genetics; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007709:Klebsiella / Q000235:genetics; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D011446:Prospective Studies; D011549:Pseudomonas / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis / Q000378:metabolism / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics; D013291:Streptococcus / Q000235:genetics; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: Antimicrobial treatment; Blood culture; Children; SeptiFast; Systemic Inflammatory Response Syndrome (SIRS)