Multiplex real-time PCR and blood culture for identification of bloodstream pathogens in patients with suspected sepsis
Multiplex real-time PCR and blood culture for identification of bloodstream pathogens in patients with suspected sepsis
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DOI：
10.1111/j.1469-0691.2009.02736.x
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发表时间：
2009-06-01
影响因子：
14.2
通讯作者：
Hoeft, A.
中科院分区：
文献类型：
--
作者：
Westh, H.;Lisby, G.;Hoeft, A.
严重脓毒症越来越成为死亡的原因。快速和正确的初始抗菌治疗可降低死亡率。血培养（BC）中并不总是能找到病原体。与BC相比，在疑似细菌或真菌败血症患者的多中心试验中，使用了一种新型多重PCR检测（SeptiFast（α版）），可直接从血液中鉴定20种细菌和真菌。对来自359名患者的558份配对样本进行了评价。BC的阳性率为17%，SeptiFast为26%。BC法分离出96株微生物，SeptiFast法鉴定出186株微生物，两者结合共鉴定出231株微生物。在96个鉴定为BC的分离株中，22个分离株被认为是污染物。在可用于与SeptiFast进行比较的其余74个非污染BC分离株中，有50个被鉴定为与配对样本中SeptiFast鉴定的菌种相同的菌种。在配对SeptiFast样本中无法检出BC中鉴定的种属的其余24种BC分离株中，18种BC分离株被鉴定为SeptiFast主列表中包含的种属，6种BC分离株被鉴定为SeptiFast主列表中未包含的种属。使用SeptiFast，鉴定出186种微生物，其中12种被认为是污染物。在使用SeptiFast鉴定的174种临床相关微生物中，BC检出了50种（29%）。用SeptiFast鉴定的剩余微生物（但在BC后未分离）中，有一半以上也在从患者采集的其他相关样本的常规培养物中发现。未来的临床研究应评估使用SeptiFast在检测血流病原体方面是否具有显著优势。
Severe sepsis is increasingly a cause of death. Rapid and correct initial antimicrobial treatment reduces mortality. The aetiological agent(s) cannot always be found in blood cultures (BCs). A novel multiplex PCR test (SeptiFast (alpha version)) that allows identification of 20 bacterial and fungal species directly from blood was used, comparatively with BC, in a multicentre trial of patients with suspected bacterial or fungal sepsis. Five hundred and fifty-eight paired samples from 359 patients were evaluated. The rate of positivity was 17% for BC and 26% for SeptiFast. Ninety-six microorganisms were isolated with BC, and 186 microorganisms were identified with SeptiFast; 231 microrganisms were found by combining the two tests. Of the 96 isolates identified with BC, 22 isolates were considered to be contaminants. Of the remaining 74 non-contaminant BC isolates available for comparison with SeptiFast, 50 were identified as a species identical to the species identified with SeptiFast in the paired sample. Of the remaining 24 BC isolates for which the species, identified in the BC, could not be detected in the paired SeptiFast sample, 18 BC isolates were identified as a species included in the SeptiFast master list, and six BC isolates were identified as a species not included in the SeptiFast master list. With SeptiFast, 186 microorganisms were identified, 12 of which were considered to be contaminants. Of the 174 clinically relevant microorganisms identified with SeptiFast, 50 (29%) were detected by BC. More than half of the remaining microorganisms identified with SeptiFast (but not isolated after BC) were also found in routine cultures of other relevant samples taken from the patients. Future clinical studies should assess whether the use of SeptiFast is of significant advantage in the detection of bloodstream pathogens.