Rapid Diagnosis of Infection in the Critically Ill, a Multicenter Study of Molecular Detection in Bloodstream Infections, Pneumonia, and Sterile Site Infections.
Rapid Diagnosis of Infection in the Critically Ill, a Multicenter Study of Molecular Detection in Bloodstream Infections, Pneumonia, and Sterile Site Infections.
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DOI：
10.1097/ccm.0000000000001249
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发表时间：
2015-11
影响因子：
8.8
通讯作者：
Rapid Diagnosis of Infections in the Critically Ill Team
中科院分区：
文献类型：
--
作者：
Vincent JL;Brealey D;Libert N;Abidi NE;O'Dwyer M;Zacharowski K;Mikaszewska-Sokolewicz M;Schrenzel J;Simon F;Wilks M;Picard-Maureau M;Chalfin DB;Ecker DJ;Sampath R;Singer M;Rapid Diagnosis of Infections in the Critically Ill Team
补充数字内容可在正文中找到。早期识别严重感染患者的致病微生物(S)是优化抗菌药物使用和患者生存的关键。然而，目前基于培养的病原体鉴定缓慢且不可靠，因此经常使用广谱抗生素来确保覆盖所有潜在的微生物，这带来了过度治疗、毒性和选择多重耐药细菌的风险。我们比较了使用一种新的、不依赖培养的聚合酶链式反应/电喷雾电离-质谱仪技术获得的结果与通过标准微生物测试获得的结果，并评估了该技术的潜在临床意义。观察性研究。六个欧洲国家的九个重症监护室。2013年10月至2014年6月期间入院的疑似或确诊为血流感染、肺炎或无菌液体和组织感染的患者被考虑纳入。没有。我们检测了616例血液感染，185例肺炎，以及来自529名患者的110份无菌液体和组织标本。在616份血液感染样本中，聚合酶链式反应/电喷雾电离-质谱仪鉴定出228例(37%)病原体，只有68例(11%)进行了培养。培养阳性13例，聚合酶链式反应/电喷雾电离质谱仪检测阴性384例，其敏感性为81%，特异性为69%，阴性预测值为97%。两种技术的生物体分布相似。对肺炎和无菌液体和组织标本也进行了类似的观察。对结果的独立临床分析表明，聚合酶链式反应/电喷雾电离-质谱仪技术可能导致高达57%的患者改变治疗。聚合酶链式反应/电喷雾电离-质谱仪在危重患者中提供快速病原体鉴定。在6小时内排除感染的能力具有潜在的临床和经济效益。
Supplemental Digital Content is available in the text. Early identification of causative microorganism(s) in patients with severe infection is crucial to optimize antimicrobial use and patient survival. However, current culture-based pathogen identification is slow and unreliable such that broad-spectrum antibiotics are often used to insure coverage of all potential organisms, carrying risks of overtreatment, toxicity, and selection of multidrug-resistant bacteria. We compared the results obtained using a novel, culture-independent polymerase chain reaction/electrospray ionization-mass spectrometry technology with those obtained by standard microbiological testing and evaluated the potential clinical implications of this technique. Observational study. Nine ICUs in six European countries. Patients admitted between October 2013 and June 2014 with suspected or proven bloodstream infection, pneumonia, or sterile fluid and tissue infection were considered for inclusion. None. We tested 616 bloodstream infection, 185 pneumonia, and 110 sterile fluid and tissue specimens from 529 patients. From the 616 bloodstream infection samples, polymerase chain reaction/electrospray ionization-mass spectrometry identified a pathogen in 228 cases (37%) and culture in just 68 (11%). Culture was positive and polymerase chain reaction/electrospray ionization-mass spectrometry negative in 13 cases, and both were negative in 384 cases, giving polymerase chain reaction/electrospray ionization-mass spectrometry a sensitivity of 81%, specificity of 69%, and negative predictive value of 97% at 6 hours from sample acquisition. The distribution of organisms was similar with both techniques. Similar observations were made for pneumonia and sterile fluid and tissue specimens. Independent clinical analysis of results suggested that polymerase chain reaction/electrospray ionization-mass spectrometry technology could potentially have resulted in altered treatment in up to 57% of patients. Polymerase chain reaction/electrospray ionization-mass spectrometry provides rapid pathogen identification in critically ill patients. The ability to rule out infection within 6 hours has potential clinical and economic benefits.