title: Microbiomic Analysis of Intra-Abdominal Infections by Using Denaturing High-Performance Liquid Chromatography: A Prospective Observational Study.
abstract: BACKGROUND
  Intra-abdominal infections represent a subgroup of septic syndromes with high death rates and the need for prompt and appropriate antimicrobial therapy. Conventional culture-based microbial identification has notable shortcomings in the diagnostics of polymicrobial infections. Modern culture-independent molecular methods may represent a new diagnostic approach. The current study aimed to compare the results obtained from the denaturing high-performance liquid chromatography WAVE®system as a culture-independent diagnostic tool with those obtained from standard culture-based microbiologic testing in the clinical setting of severe intra-abdominal sepsis.
  
  
  METHODS
  The study included 42 samples of pathologic intra-abdominal fluids, collected from 37 patients with intra-abdominal sepsis. Micro-organisms grown in culture and detected by the WAVE system were compared. Further, we recorded clinical data including baseline characteristics and the use of antibiotic agents.
  
  
  RESULTS
  In 38.1% of the analyzed samples, the classic, culture-based methods showed no bacterial growth on agar plates, in comparison with the microbiomic analysis in which the proportion of samples with negative signal was 31%. In about 40% of the patients, both methods detected one microbiologic agent, whereas in approximately one quarter of the samples, two or more agents were identified. The detection rate of certain bacteria such as Enterobacteriacae or Enterococcus faecium was significantly higher using the microbiomic analysis. Bacteria such as Haemophilus, Lactobacillus, Clostridium, Methylobacterium, Collinsella aerofaciens, and Solobacterium moorei were detected exclusively using microbiomic analysis.
  
  
  CONCLUSIONS
  The culture independent molecular WAVE system provided additional information, especially concerning unusual, fastidious bacteria in patients with intra-abdominal infections. Further, it has a higher detection rate for polymicrobial infection and delivers results much sooner than conventional microbiologic methods.
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Christian
authors.initials: C
authors.lastname: Koch
authors.affiliation: 2 Department of General Surgery, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Anca L
authors.initials: AL
authors.lastname: Amati
authors.affiliation: 2 Department of General Surgery, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Andreas
authors.initials: A
authors.lastname: Hecker
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Marcel
authors.initials: M
authors.lastname: Höxter
authors.affiliation: 4 Department of General Surgery, Hospital Worms GmbH , Worms, Germany .
authors.forename: Marcus
authors.initials: M
authors.lastname: Hirschburger
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Reginald
authors.initials: R
authors.lastname: Matejec
authors.affiliation: 2 Department of General Surgery, University Hospital of Giessen and Marburg , Giessen, Germany .
authors.forename: Winfried
authors.initials: W
authors.lastname: Padberg
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg , Giessen, Germany .|3 Department of Anesthesiology, Heidelberg University Hospital , Heidelberg, Germany .
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Weigand
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg , Giessen, Germany .|3 Department of Anesthesiology, Heidelberg University Hospital , Heidelberg, Germany .
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichtenstern
authors.affiliation: 5 Institute of Medical Microbiology, German Centre for Infection Research (DZIF Partner Site Giessen-Marburg-Langen), Justus-Liebig-University , Giessen, Germany .
authors.forename: Eugen
authors.initials: E
authors.lastname: Domann
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D002851:Chromatography, High Pressure Liquid / Q000379:methods*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis* / Q000382:microbiology*; D008297:Male; D008828:Microbiological Techniques / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D011489:Protein Denaturation; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: abdominal infection; antimicrobial management; diagnosis; intra-abdominal infection; sepsis