Microbial diagnostics in patients with presumed severe infection in the emergency department
Microbial diagnostics in patients with presumed severe infection in the emergency department
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DOI：
10.1007/s00063-011-0051-4
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发表时间：
2012-02-01
影响因子：
1.1
通讯作者：
Werdan, K.
中科院分区：
文献类型：
--
作者：
Hettwer, S.;Wilhelm, J.;Werdan, K.
导论.早期脓毒症是急诊科常见病，快速诊断至关重要。我们的目的是比较病原体诊断使用血培养（BC）和多重聚合酶链反应（PCR）测试。在2006年和2009年之间，我们的大学医院的多学科急诊科共收治了211例疑似严重感染的任何来源进行了研究。入院后立即采集血液样本进行BC（需氧和厌氧）和多重PCR鉴定感染性微生物。BC和PCR的结果与降钙素原浓度（PCT）和脓毒症的临床诊断（≥ 2个阳性SIRS标准）以及入院时疾病的严重程度和临床结局指标相关。200例（94.8%）患者的BC结果可用，119例（56.3%）患者的PCR结果可用。总共有87个BC（43.5%）呈阳性，并确定了94个病原体。在45例阳性PCR中，共检出47种病原体（37.8%），其中81.4%的PCR结果与临床诊断相符。此外，BC鉴定出9种革兰氏阳性菌和3种革兰氏阴性菌，而PCR增加了5种革兰氏阴性病原菌。仅在血培养中检测到凝固酶阴性葡萄球菌（n=20，21.3%），而PCR鉴定出的革兰氏阴性菌明显多于BC。在PCR阳性患者中，PCT水平显著高于PCR阴性患者（15.0 +/- 23.3 vs. 8.8 +/- 32.8 ng/ml，p
Introduction. Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (>= 2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures.Results. Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only (n=20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0 +/- 23.3 vs. 8.8 +/- 32.8 ng/ml, p