Therapeutic impact and diagnostic performance of multiplex PCR in patients with malignancies and suspected sepsis
Therapeutic impact and diagnostic performance of multiplex PCR in patients with malignancies and suspected sepsis
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DOI：
10.1016/j.jinf.2010.07.004
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发表时间：
2010-10-01
影响因子：
28.2
通讯作者：
Timsit, Jean-Francois
中科院分区：
文献类型：
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作者：
Maubon, Daniele;Hamidfar-Roy, Rebecca;Timsit, Jean-Francois
目的：新的分子方法可以快速检测脓毒症患者的病原体，但其对治疗决策的影响仍有待确定。我们评估了多重PCR检测在癌症和脓毒症患者中的治疗价值。方法：前瞻性纳入110例癌症和脓毒症患者，除标准检测外，还进行了LightCycler（R）SeptiFast（LC-SF）多重PCR检测。两个独立的专家小组根据病历数据评估了每位患者的诊断;只有一个小组有LC-SF结果。由第三面板建立的最终诊断是参考standard.Results：最终诊断记录败血症50例（55微生物），无证败血症54，和非感染性疾病6。LC-SF检测到17/32例从血培养（BC）中回收的病原体和11/23例未从BC中回收的病原体; 12种微生物既未通过BC也未通过LC-SF检出。LC-SF假阳性10例。LC-SF结果将显着改善11例（10%）患者的治疗，并促使3例患者最初未立即给予抗菌治疗。结论：在疑似败血症的癌症患者中，LC-SF检测到11/55（20%）未从BC中恢复的真正病原体，并将改善11/110（10%）患者的初始管理。(C)2010年英国感染学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: New molecular methods allow rapid pathogen detection in patients with sepsis, but their impact on treatment decisions remains to be established. We evaluated the therapeutic usefulness of multiplex PCR testing in patients with cancer and sepsis.Methods: 110 patients with cancer and sepsis were included prospectively and underwent LightCycler (R) SeptiFast (LC-SF) multiplex PCR testing in addition to standard tests. Two independent panels of experts assessed the diagnosis in each patient based on medical record data; only one panel had the LC-SF results. The final diagnosis established by a third panel was the reference standard.Results: The final diagnosis was documented sepsis in 50 patients (55 microorganisms), undocumented sepsis in 54, and non-infectious disease in 6. LC-SF detected 17/32 pathogens recovered from blood cultures (BC) and 11/23 pathogens not recovered from BC; 12 microorganisms were detected neither by BC nor by LC-SF. LC-SF produced false-positive results in 10 cases. The LC-SF results would have significantly improved treatment in 11 (10%) patients and prompted immediate antimicrobial therapy not given initially in 3 patients.Conclusions: In cancer patients with suspected sepsis, LC-SF detected 11/55 (20%) true pathogens not recovered from BCs and would have improved the initial management in 11/110 (10%) patients. (C) 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.