Pilarczyk, Kevin, Rath, Peter-Michael, Steinmann, Joerg, Thielmann, Matthias, Padosch, Stephan A., Duerbeck, Max, Jakob, Heinz and Dusse, Fabian ORCID: 0000-0001-7762-6966 (2019). Multiplex polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery. BMC Anesthesiol., 19. LONDON: BMC. ISSN 1471-2253

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Abstract

BackgroundSepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas conventional blood culture (BC) suffers from low sensitivity as well as a reporting delay of approximately 48-72h, real-time multiplex polymerase chain reaction (PCR) based technologies like SeptiFast (SF) might offer a fast and reliable alternative for detection of bloodstream infections (BSI). The aim of this study was to compare the performance of SF with BC testing in patients suspected of having BSI after cardiac surgery.MethodsTwo hundred seventy-nine blood samples from 169 individuals with suspected BSI were analyzed by SF and BC. After excluding results attributable to contaminants, a comparison between the two groups were carried out. Receiver operating characteristic (ROC) curves were generated to determine the accuracy of clinical and laboratory values for the prediction of positive SF results.Results14.7% (n=41) of blood samples were positive using SF and 17.2% (n=49) using BC (n.s. [p>0.05]). In six samples SF detected more than one pathogen. Among the 47 microorganisms identified by SF, only 11 (23.4%) could be confirmed by BC. SF identified a higher number of Gram-negative bacteria than BC did (28 vs. 12, (2)=7.97, p=0.005). The combination of BC and SF increased the number of detected microorganisms, including fungi, compared to BC alone (86 vs. 49, (2)=13.51, p<0.001). C-reactive protein (CRP) (21.711.41 vs. 16.0 +/- 16.9mg/dl, p=0.009), procalcitonin (28.7 +/- 70.9 vs. 11.5 +/- 30.4ng/dl, p=0.015), and interleukin 6 (IL 6) (932.3 +/- 1306.7 vs. 313.3 +/- 686.6pg/ml, p=0.010) plasma concentrations were higher in patients with a positive SF result. Using ROC analysis, IL-6 (AUC 0.836) and CRP (AUC 0.804) showed the best predictive values for positive SF results.Conclusion The SF test represent a valuable method for rapid etiologic diagnosis of BSI in patients after cardiothoracic surgery. In particular this method applies for individuals with suspected Gram-negative blood stream. Due to the low performance in detecting Gram-positive pathogens and the inability to determine antibiotic susceptibility, it should be used in addition to BC only (Pilarczyk K, et al., Intensive Care Med Exp ,3(Suppl. 1):A884, 2015).

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Pilarczyk, KevinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rath, Peter-MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steinmann, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thielmann, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Padosch, Stephan A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Duerbeck, MaxUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jakob, HeinzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dusse, FabianUNSPECIFIEDorcid.org/0000-0001-7762-6966UNSPECIFIED
URN: urn:nbn:de:hbz:38-150423
DOI: 10.1186/s12871-019-0727-5
Journal or Publication Title: BMC Anesthesiol.
Volume: 19
Date: 2019
Publisher: BMC
Place of Publication: LONDON
ISSN: 1471-2253
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
DOCUMENTED NOSOCOMIAL INFECTIONS; INTENSIVE-CARE-UNIT; REAL-TIME PCR; FUNGAL-INFECTIONS; IDENTIFICATION; SEPSIS; MORTALITY; SEPTIFAST; CULTURES; RISKMultiple languages
AnesthesiologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/15042

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