Troeger, Birte, Haertel, Christoph, Buer, Jan ORCID: 0000-0002-7602-1698, Doerdelmann, Michael, Felderhoff-Mueser, Ursula, Hoehn, Thomas, Hepping, Nico, Hillebrand, Georg, Kribs, Angela, Marissen, Janina, Olbertz, Dirk, Rath, Peter-Michael, Schmidtke, Susanne, Siegel, Jens, Herting, Egbert, Goepel, Wolfgang, Steinmann, Joerg and Stein, Anja (2016). Clinical Relevance of Pathogens Detected by Multiplex PCR in Blood of Very-Low-Birth Weight Infants with Suspected Sepsis - Multicentre Study of the German Neonatal Network. PLoS One, 11 (7). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Introduction In the German Neonatal Network (GNN) 10% of very-low-birth weight infants (VLBWI) suffer from blood-culture confirmed sepsis, while 30% of VLBWI develop clinical sepsis. Diagnosis of sepsis is a difficult task leading to potential over-treatment with antibiotics. This study aims to investigate whether the results of blood multiplex-PCR (SeptiFast (R)) for common sepsis pathogens are relevant for clinical decision making when sepsis is suspected in VLBWI. Methods We performed a prospective, multi-centre study within the GNN including 133 VLBWI with 214 episodes of suspected late onset sepsis (LOS). In patients with suspected sepsis a multiplex-PCR (LightCycler SeptiFast MGRADE-test (R)) was performed from 100 mu l EDTA blood in addition to center-specific laboratory biomarkers. The attending neonatologist documented whether the PCR-result, which was available after 24 to 48 hrs, had an impact on the choice of antibiotic drugs and duration of therapy. Results PCR was positive in 110/214 episodes (51%) and blood culture (BC) was positive in 55 episodes (26%). Both methods yielded predominantly coagulase-negative staphylococci (CoNS) followed by Escherichia coli and Staphylococcus aureus. In 214 BC-PCR paired samples concordant results were documented in 126 episodes (59%; n = 32 were concordant pathogen positive results, n = 94 were negative in both methods). In 65 episodes (30%) we found positive PCR results but negative BCs, with CoNS being identified in 43 (66%) of these samples. Multiplex-PCR results influenced clinical decision making in 30% of episodes, specifically in 18% for the choice of antimicrobial therapy and in 22% for the duration of antimicrobial therapy. Conclusions Multiplex-PCR results had a moderate impact on clinical management in about one third of LOS-episodes. The main advantage of multiplex-PCR was the rapid detection of pathogens from micro-volume blood samples. In VLBWI limitations include risk of contamination, lack of resistance testing and high costs. The high rate of positive PCR results in episodes of negative BC might lead to overtreatment of infants which is associated with risk of mortality, antibiotic resistance, fungal sepsis and NEC.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Troeger, BirteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haertel, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buer, JanUNSPECIFIEDorcid.org/0000-0002-7602-1698UNSPECIFIED
Doerdelmann, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Felderhoff-Mueser, UrsulaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoehn, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hepping, NicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hillebrand, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kribs, AngelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marissen, JaninaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Olbertz, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rath, Peter-MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidtke, SusanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Siegel, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Herting, EgbertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goepel, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steinmann, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stein, AnjaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-269407
DOI: 10.1371/journal.pone.0159821
Journal or Publication Title: PLoS One
Volume: 11
Number: 7
Date: 2016
Publisher: PUBLIC LIBRARY SCIENCE
Place of Publication: SAN FRANCISCO
ISSN: 1932-6203
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
REAL-TIME PCR; LATE-ONSET SEPSIS; STREAM INFECTIONS; MOLECULAR-DETECTION; DIAGNOSIS; DIFFERENTIATION; CULTUREMultiple languages
Multidisciplinary SciencesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/26940

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