Multiplex polymerase chain reaction pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery.
Multiplex polymerase chain reaction pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery.
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外伤、急诊和烧伤手术后疑似败血症患者的多重聚合酶链反应病原体检测。
DOI：
10.1016/j.surg.2011.07.030
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发表时间：
2012
期刊：
影响因子：
3.8
通讯作者：
Kost,GeraldJ
中科院分区：
文献类型：
--
作者：
Tran,NamK;Wisner,DavidH;Albertson,TimothyE;Cohen,Stuart;Greenhalgh,David;Palmieri,TinaL;Polage,Christopher;Kost,GeraldJ
背景本研究的目的是确定多重聚合酶链反应（PCR）研究对于加强外伤、急诊和烧伤手术后疑似败血症患者病原体检测的临床价值。基于 PCR 的病原体检测可快速揭示这些高危患者的隐匿性血流感染，并可能加速靶向抗菌治疗的启动。方法我们进行了一项前瞻性观察研究，比较了 30 名创伤和急诊手术患者与 20 名烧伤患者的结果。使用基于 PCR 的新型多重病原体检测系统对通过常规血培养 (BC) 收集的全血样本进行了检测。将PCR结果与培养数据进行比较。结果PCR比培养方法更快地检测到更多的病原体。 PCR 阳性创伤和急诊手术患者的急性生理学和慢性健康评估 II (APACHE II)、序贯器官衰竭评估 (SOFA) 和多器官功能障碍 (MODS) 评分高于 PCR 阴性创伤和急诊手术患者 (P ≤ .033)。阴性 PCR 结果（比值比，0.194；95% 置信区间，0.045–0.840；P = .028）是联合手术患者群体生存的独立预测因子。 结论 PCR 检测到病原体的存在比血培养更频繁。这些 PCR 结果的报告速度比血培养结果更快。 PCR 阳性的创伤和急诊手术患者的严重程度评分明显更高。 PCR 测定的病原体 DNA 缺失是合并患者群体生存的重要预测指标。独立于传统培养提示的 PCR 检测可能对烧伤患者具有临床价值。这些结果值得通过干预试验进一步研究。
BACKGROUNDThe goal of this study is to determine the clinical value of multiplex polymerase chain reaction (PCR) study for enhancing pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery. PCR-based pathogen detection quickly reveals occult bloodstream infections in these high-risk patients and may accelerate the initiation of targeted antimicrobial therapy.METHODSWe conducted a prospective observational study comparing results for 30 trauma and emergency surgery patients to 20 burn patients. Whole-blood samples collected with routine blood cultures (BCs) were tested using a new multiplex, PCR-based, pathogen detection system. PCR results were compared to culture data.RESULTSPCR detected rapidly more pathogens than culture methods. Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction (MODS) scores were greater in PCR-positive versus PCR-negative trauma and emergency surgery patients (P ≤ .033). Negative PCR results (odds ratio, 0.194; 95% confidence interval, 0.045–0.840; P = .028) acted as an independent predictor of survival for the combined surgical patient population.CONCLUSIONPCR detected the presence of pathogens more frequently than blood culture. These PCR results were reported faster than blood culture results. Severity scores were significantly greater in PCR-positive trauma and emergency surgery patients. The lack of pathogen DNA as determined by PCR served as a significant predictor of survival in the combined patient population. PCR testing independent of traditional prompts for culturing may have clinical value in burn patients. These results warrant further investigation through interventional trials.
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影响因子：
4.1
作者：
Maaroufi, Y;De Bruyne, JM;Crokaert, F
通讯作者：
Crokaert, F
影响因子：
28.2
作者：
Maubon, Daniele;Hamidfar-Roy, Rebecca;Timsit, Jean-Francois
通讯作者：
Timsit, Jean-Francois
影响因子：
9.4
作者：
Ho, Ya-Chi;Chang, Shan-Chwen;Wang, Wei-Kung
通讯作者：
Wang, Wei-Kung
院内血流感染的危险因素。
影响因子：
--
作者：
Eleni Apostolopolou;G. Katsaris;T. Katostaras
通讯作者：
T. Katostaras
烧伤后的免疫调节。
DOI：
10.1016/s0039-6109(16)44134-4
发表时间：
1987
期刊：
The Surgical clinics of North America
影响因子：
--
作者：
J. Hansbrough;R. Zapata;V. Peterson
通讯作者：
V. Peterson