The effect of empiric antimicrobial treatment duration on detection of bacterial DNA in sterile surgical specimens.
Initial antimicrobial treatment of patients with deep seated or invasive infections is typically empiric. Usually, cultures of specimens obtained from the suspected source of infection are performed to identify pathogens and guide continued antimicrobial treatment. When patients present with signs and symptoms of infection, but sterile body fluid or tissue specimens cannot be obtained in a timely fashion, growth of bacterial pathogens in culture may be inhibited following initiation of empiric antibiotic treatment. To address this clinical dilemma, we performed a prospective evaluation of conventional culture vs. PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS) on sterile body fluids and tissues submitted to the diagnostic microbiology lab following initiation of empiric antibiotic treatment for patients with suspected infection. In this series of surgical samples, PCR/ESI-MS identified bacterial pathogen(s) in 56% (49/87) of patients with non-diagnostic cultures. Examination of patients stratified by antibiotic treatment duration demonstrated that PCR/ESI-MS sustains high rates of bacterial DNA detection over time by generalized estimating equation models (p<0.0001).
Department of Medicine, University of Illinois College of Medicine, Peoria, Illinois, United States of America.|Department of Laboratory Medicine, Division of Clinical Microbiology & Serology, OSF System Lab, Peoria, Illinois, United States of America.
John Joseph
JJ
Farrell
Department of Medicine, University of Illinois College of Medicine, Peoria, Illinois, United States of America.
Huaping
H
Wang
Ibis Biosciences, an Abbott Company, Carlsbad, California, United States of America.
Rangarajan
R
Sampath
Ibis Biosciences, an Abbott Company, Carlsbad, California, United States of America.
Kristin S
KS
Lowery
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States of America.|Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America.|Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States of America.|Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, United States of America.
Robert A
RA
Bonomo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000235:genetics*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D058491:Bacterial Load; D004269:DNA, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D021241:Spectrometry, Mass, Electrospray Ionization; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial