Rapid identification and differentiation of Gram-negative and Gram-positive bacterial bloodstream infections by quantitative polymerase chain reaction in preterm infants
Rapid identification and differentiation of Gram-negative and Gram-positive bacterial bloodstream infections by quantitative polymerase chain reaction in preterm infants
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DOI：
10.1097/ccm.0b013e3181a554de
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发表时间：
2009-08-01
影响因子：
8.8
通讯作者：
Ng, Pak C.
中科院分区：
文献类型：
--
作者：
Chan, Kathy Y. Y.;Lam, Hugh S.;Ng, Pak C.
Objective.为了评价革兰氏特异性探针定量聚合酶链反应试验用于快速检测和区分早产儿革兰氏阴性和革兰氏阳性细菌血流感染的有效性。设计：横断面研究。大学附属三级新生儿重症监护病房。临床特征提示迟发性感染的早产儿。干预：无。测量和主要结果。除了完整的脓毒症筛查外，无菌采集0.5 mL EDTA血液用于革兰氏特异性定量聚合酶链反应评价。分析了血液和其他体液（包括腹膜液和脑脊液）中细菌培养的结果。定量聚合酶链反应的诊断效用进行了测定。共调查了218起疑似感染事件，其中42起为培养阳性，176起为培养阴性。对于革兰阴性菌感染，定量聚合酶链反应试验正确识别22例中的19例，敏感性和特异性分别为86.4%和99.0%。对于革兰阳性菌感染，该试验正确识别了14/19次发作，敏感性和特异性分别为73.7%和98.5%。其余1例为白色念珠菌败血症。定量聚合酶链反应试验阳性的事件均未被归类为错误的革兰氏染色类别。更重要的是，尽管5名患有腹腔内脓毒症（腹膜炎[n = 4]和肝脾脓肿[n = 1]）的婴儿的血培养结果为阴性，但定量聚合酶链反应试验可以检测血液中革兰氏特异性致病微生物。革兰氏特异性定量聚合酶链反应试验是一种可靠和高度特异性的快速鉴定和区分革兰氏阴性和革兰氏阳性血流和腹腔内感染。样品到达实验室后5小时内可获得结果。一个积极的测试是能够在血液培养结果变得可用之前“规则”细菌血流感染，并作为一个指导，以预测致病微生物的毒力，根据其革兰氏特异性分类，使危重患者可以有针对性地进行强化治疗。(Crit Care Med 2009; 37：2441-2447）
Objective. To evaluate the usefulness of the Gram-specific probe-based quantitative polymerase chain reaction test for rapid detection and differentiation of Gram-negative and Gram-positive bacterial bloodstream infection in preterm infants.Design: Cross-sectional study.Setting. University-affiliated Level III neonatal intensive care unit.Patients. Preterm infants with clinical features suggestive of late-onset infection.Interventions: None.Measurements and Main Results. In addition to the full sepsis screen, 0.5 mL of EDTA blood was collected aseptically for Gram-specific quantitative polymerase chain reaction evaluation. The results were analyzed with respect to outcomes of bacterial culture in blood and other body fluids, including peritoneal and cerebrospinal fluids. The diagnostic utilities of the quantitative polymerase chain reaction were determined. A total of 218 suspected infection episodes were investigated, of which 42 episodes were culture positive and 176 were culture negative. For Gram-negative infection, the quantitative polymerase chain reaction test correctly identified 19 of 22 episodes, and the sensitivity and specificity were 86.4% and 99.0%, respectively. For Gram-positive infection, the test correctly identified 14/19 episodes, and the sensitivity and specificity were 73.7% and 98.5%. The remaining one episode Was Candida albicans septicemia. None of the episodes with positive quantitative polymerase chain reaction test were classified into the wrong Gram stain category. More importantly, despite negative blood culture in five infants suffering from intra-abdominal sepsis (peritonitis [n = 4] and hepatosplenic abscess [n = 1]), the quantitative polymerase chain reaction test could detect the Gram-specific category of causative organisms in blood.Conclusions. The Gram-specific quantitative polymerase chain reaction test is reliable and highly specific for rapid identification and differentiation of Gram-negative and Gram-positive bloodstream and intra-abdominal infections. The result could be made available within 5 hrs after the specimen reaches the laboratory. A positive test-is able to "rule in" bacterial bloodstream infection before blood culture results become available, and serves as a guide to predict the virulence of the causative organism according to its Gram-specific category so that critical patients can be targeted for intensive treatment. (Crit Care Med 2009; 37: 2441-2447)