Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery
Abstract Background Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, real-time multiplex polymerase chai...
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doaj-0a6252b772454166b371169580cda80f2020-11-25T02:36:41ZengBMCBMC Anesthesiology1471-22532019-04-0119111110.1186/s12871-019-0727-5Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgeryKevin Pilarczyk0Peter-Michael Rath1Joerg Steinmann2Matthias Thielmann3Stephan A. Padosch4Max Dürbeck5Heinz Jakob6Fabian Dusse7Department of Intensive Care Medicine, imland Klinik Rendsburg managed by Sana GmbHInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-EssenInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-EssenDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital of CologneDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, University of Duisburg-EssenDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital of CologneAbstract Background Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, real-time multiplex polymerase chain reaction (PCR) based technologies like “SeptiFast” (SF) might offer a fast and reliable alternative for detection of bloodstream infections (BSI). The aim of this study was to compare the performance of SF with BC testing in patients suspected of having BSI after cardiac surgery. Methods Two hundred seventy-nine blood samples from 169 individuals with suspected BSI were analyzed by SF and BC. After excluding results attributable to contaminants, a comparison between the two groups were carried out. Receiver operating characteristic (ROC) curves were generated to determine the accuracy of clinical and laboratory values for the prediction of positive SF results. Results 14.7% (n = 41) of blood samples were positive using SF and 17.2% (n = 49) using BC (n.s. [p > 0.05]). In six samples SF detected more than one pathogen. Among the 47 microorganisms identified by SF, only 11 (23.4%) could be confirmed by BC. SF identified a higher number of Gram-negative bacteria than BC did (28 vs. 12, χ2 = 7.97, p = 0.005). The combination of BC and SF increased the number of detected microorganisms, including fungi, compared to BC alone (86 vs. 49, χ2 = 13.51, p < 0.001). C-reactive protein (CRP) (21.7 ± 11.41 vs. 16.0 ± 16.9 mg/dl, p = 0.009), procalcitonin (28.7 ± 70.9 vs. 11.5 ± 30.4 ng/dl, p = 0.015), and interleukin 6 (IL 6) (932.3 ± 1306.7 vs. 313.3 ± 686.6 pg/ml, p = 0.010) plasma concentrations were higher in patients with a positive SF result. Using ROC analysis, IL-6 (AUC 0.836) and CRP (AUC 0.804) showed the best predictive values for positive SF results. Conclusion The SF test represent a valuable method for rapid etiologic diagnosis of BSI in patients after cardiothoracic surgery. In particular this method applies for individuals with suspected Gram-negative blood stream. Due to the low performance in detecting Gram-positive pathogens and the inability to determine antibiotic susceptibility, it should be used in addition to BC only (Pilarczyk K, et al., Intensive Care Med Exp ,3(Suppl. 1):A884, 2015).http://link.springer.com/article/10.1186/s12871-019-0727-5Blood stream infectionBlood cultureReal time multiplex polymerase chain reaction |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kevin Pilarczyk Peter-Michael Rath Joerg Steinmann Matthias Thielmann Stephan A. Padosch Max Dürbeck Heinz Jakob Fabian Dusse |
spellingShingle |
Kevin Pilarczyk Peter-Michael Rath Joerg Steinmann Matthias Thielmann Stephan A. Padosch Max Dürbeck Heinz Jakob Fabian Dusse Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery BMC Anesthesiology Blood stream infection Blood culture Real time multiplex polymerase chain reaction |
author_facet |
Kevin Pilarczyk Peter-Michael Rath Joerg Steinmann Matthias Thielmann Stephan A. Padosch Max Dürbeck Heinz Jakob Fabian Dusse |
author_sort |
Kevin Pilarczyk |
title |
Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
title_short |
Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
title_full |
Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
title_fullStr |
Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
title_full_unstemmed |
Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
title_sort |
multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2019-04-01 |
description |
Abstract Background Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, real-time multiplex polymerase chain reaction (PCR) based technologies like “SeptiFast” (SF) might offer a fast and reliable alternative for detection of bloodstream infections (BSI). The aim of this study was to compare the performance of SF with BC testing in patients suspected of having BSI after cardiac surgery. Methods Two hundred seventy-nine blood samples from 169 individuals with suspected BSI were analyzed by SF and BC. After excluding results attributable to contaminants, a comparison between the two groups were carried out. Receiver operating characteristic (ROC) curves were generated to determine the accuracy of clinical and laboratory values for the prediction of positive SF results. Results 14.7% (n = 41) of blood samples were positive using SF and 17.2% (n = 49) using BC (n.s. [p > 0.05]). In six samples SF detected more than one pathogen. Among the 47 microorganisms identified by SF, only 11 (23.4%) could be confirmed by BC. SF identified a higher number of Gram-negative bacteria than BC did (28 vs. 12, χ2 = 7.97, p = 0.005). The combination of BC and SF increased the number of detected microorganisms, including fungi, compared to BC alone (86 vs. 49, χ2 = 13.51, p < 0.001). C-reactive protein (CRP) (21.7 ± 11.41 vs. 16.0 ± 16.9 mg/dl, p = 0.009), procalcitonin (28.7 ± 70.9 vs. 11.5 ± 30.4 ng/dl, p = 0.015), and interleukin 6 (IL 6) (932.3 ± 1306.7 vs. 313.3 ± 686.6 pg/ml, p = 0.010) plasma concentrations were higher in patients with a positive SF result. Using ROC analysis, IL-6 (AUC 0.836) and CRP (AUC 0.804) showed the best predictive values for positive SF results. Conclusion The SF test represent a valuable method for rapid etiologic diagnosis of BSI in patients after cardiothoracic surgery. In particular this method applies for individuals with suspected Gram-negative blood stream. Due to the low performance in detecting Gram-positive pathogens and the inability to determine antibiotic susceptibility, it should be used in addition to BC only (Pilarczyk K, et al., Intensive Care Med Exp ,3(Suppl. 1):A884, 2015). |
topic |
Blood stream infection Blood culture Real time multiplex polymerase chain reaction |
url |
http://link.springer.com/article/10.1186/s12871-019-0727-5 |
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