Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia
Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia
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DOI：
10.1128/jcm.38.7.2574-2578.2000
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发表时间：
2000-07-01
影响因子：
9.4
通讯作者：
Durso, MB
中科院分区：
文献类型：
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作者：
Jordan, JA;Durso, MB
在美国出生的婴儿中，每年有10%进入新生儿重症监护室（NICU）。这些入院的婴儿中约有一半来自有全身感染风险的足月婴儿（妊娠>34周）。大多数足月婴儿没有感染，而是具有与其他类似败血症的医学状况一致的症状，目前用于评估新生儿细菌性败血症的护理标准是进行血液培养并提供抗生素治疗，同时等待48小时的初步培养结果。在足月新生儿中实施更快速的排除败血症的方法可能会导致更短的NICU停留时间和更少的抗生素使用。本可行性研究的目的是比较PCR与传统培养的效用。为此，共收集了548对血液样本，从婴儿入院到新生儿重症监护病房的疑似败血症进行了分析，细菌生长使用BACTEC 9240仪器和细菌16S rRNA基因使用PCR检测，其中包括5小时的预扩增培养步骤。在548份标本中，培养和PCR的阳性率分别为25份（4.6%）和27份（4.9%）。比较显示，PCR的灵敏度，特异性，阳性和阴性预测值分别为96.0%，99.4%，88.9%和99.8%。总之，这种基于PCR的方法，需要少至9小时的周转时间和小至200 μ l的血液体积，以及与传统的血液培养结果怀疑有细菌性败血症的新生儿。
Ten percent of infants born in the United States are admitted to neonatal intensive care units (NICU) annually. Approximately one-half of these admissions are from term infants (>34 weeks of gestation) at risk for systemic infection. Most of the term infants are not infected but rather have symptoms consistent with other medical conditions that mimic sepsis, The current standard of care for evaluating bacterial sepsis in the newborn is performing blood culturing and providing antibiotic therapy while awaiting the 48-h preliminary result of culture. Implementing a more rapid means of ruling out sepsis in term newborns could result in shorter NICU stays and less antibiotic usage. The purpose of this feasibility study was to compare the utility of PCR to that of conventional culture. To this end, a total of 548 paired blood samples collected from infants admitted to the NICU for suspected sepsis were analyzed for bacterial growth using the BACTEC 9240 instrument and for the bacterial 16S rRNA gene using a PCR assay which included a 5-h preamplification culturing step. The positivity rates by culture and PCR were 25 (4.6%) and 27 (4.9%) positive specimens out of a total of 548 specimens, respectively. The comparison revealed sensitivity, specificity, and positive and negative predictive values of 96.0, 99.4, 88.9, and 99.8%, respectively, for PCR, In summary, this PCR-based approach, requiring as little as 9 h of turnaround time and blood volumes as small as 200 mu l, correlated well with conventional blood culture results obtained for neonates suspected of having bacterial sepsis.