Incremental value of multiplex real-time PCR for the early diagnosis of sepsis in the emergency department
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Incremental value of multiplex real-time PCR for the early diagnosis of sepsis in the emergency department. / Schaub, Nora; Boldanova, Tujana; Noveanu, Markus; Arenja, Nisha; Hermann, Heinz; Twerenbold, Raphael; Frei, Reno; Bingisser, Roland; Trampuz, Andrej; Mueller, Christian.
in: SWISS MED WKLY, Jahrgang 144, 04.02.2014, S. w13911.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Incremental value of multiplex real-time PCR for the early diagnosis of sepsis in the emergency department
AU - Schaub, Nora
AU - Boldanova, Tujana
AU - Noveanu, Markus
AU - Arenja, Nisha
AU - Hermann, Heinz
AU - Twerenbold, Raphael
AU - Frei, Reno
AU - Bingisser, Roland
AU - Trampuz, Andrej
AU - Mueller, Christian
PY - 2014/2/4
Y1 - 2014/2/4
N2 - BACKGROUND: Delayed recognition of sepsis and inappropriate initial antibiotic therapy are associated with increased mortality and morbidity. The early detection of the causative organism in sepsis is an unmet clinical need. A novel multiplex real-time polymerase chain reaction (MRT-PCR) (SeptiFast®) technique may provide the microbiological diagnosis within six hours.METHODS: We assessed the diagnostic accuracy of blood cultures and MRT-PCR in a comparative diagnostic cohort study in 110 consecutive adult patients presenting to the emergency department (ED) with suspected sepsis.RESULTS: We collected 205 corresponding PCR samples and blood culture (BC) pairs from the 110 patients. There was moderate to high concordance between PCR and BC with 181 (88%) matching and 24 (12%) mismatching samples. The diagnostic accuracy of MRT-PCR in detecting sepsis and its causative organism was comparable to that of BCs. The additional use of MRT-PCR significantly reduced the time to microbiological diagnosis as compared to the use of conventional microbiological methods alone (mean time gained 3.9 hours, range 0-66 hours, p <0.001).CONCLUSION: Diagnostic accuracy of BCs and MRT-PCR in the early diagnosis of sepsis and its causative organism in the ED are comparable. However, MRT-PCR reduces the time to microbiological diagnosis. Whether a more rapid detection of the organism by MRT-PCR could improve the outcome of patients has to be assessed in large prospective randomised trials.
AB - BACKGROUND: Delayed recognition of sepsis and inappropriate initial antibiotic therapy are associated with increased mortality and morbidity. The early detection of the causative organism in sepsis is an unmet clinical need. A novel multiplex real-time polymerase chain reaction (MRT-PCR) (SeptiFast®) technique may provide the microbiological diagnosis within six hours.METHODS: We assessed the diagnostic accuracy of blood cultures and MRT-PCR in a comparative diagnostic cohort study in 110 consecutive adult patients presenting to the emergency department (ED) with suspected sepsis.RESULTS: We collected 205 corresponding PCR samples and blood culture (BC) pairs from the 110 patients. There was moderate to high concordance between PCR and BC with 181 (88%) matching and 24 (12%) mismatching samples. The diagnostic accuracy of MRT-PCR in detecting sepsis and its causative organism was comparable to that of BCs. The additional use of MRT-PCR significantly reduced the time to microbiological diagnosis as compared to the use of conventional microbiological methods alone (mean time gained 3.9 hours, range 0-66 hours, p <0.001).CONCLUSION: Diagnostic accuracy of BCs and MRT-PCR in the early diagnosis of sepsis and its causative organism in the ED are comparable. However, MRT-PCR reduces the time to microbiological diagnosis. Whether a more rapid detection of the organism by MRT-PCR could improve the outcome of patients has to be assessed in large prospective randomised trials.
KW - Aged
KW - Bacteremia/blood
KW - Blood/microbiology
KW - Blood Chemical Analysis
KW - DNA, Bacterial/analysis
KW - DNA, Fungal/analysis
KW - Early Diagnosis
KW - Emergency Service, Hospital
KW - Female
KW - Fungemia/blood
KW - Humans
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Real-Time Polymerase Chain Reaction
KW - Single-Blind Method
KW - Time Factors
U2 - 10.4414/smw.2014.13911
DO - 10.4414/smw.2014.13911
M3 - SCORING: Journal article
C2 - 24496744
VL - 144
SP - w13911
JO - SWISS MED WKLY
JF - SWISS MED WKLY
SN - 1424-7860
ER -