Universität zu Köln

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:	Creators Email ORCID ORCID Put Code Troeger, Birte UNSPECIFIED UNSPECIFIED UNSPECIFIED Haertel, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Buer, Jan UNSPECIFIED orcid.org/0000-0002-7602-1698 UNSPECIFIED Doerdelmann, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Felderhoff-Mueser, Ursula UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoehn, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Hepping, Nico UNSPECIFIED UNSPECIFIED UNSPECIFIED Hillebrand, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Kribs, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Marissen, Janina UNSPECIFIED UNSPECIFIED UNSPECIFIED Olbertz, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Rath, Peter-Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidtke, Susanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Siegel, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Herting, Egbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Goepel, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Steinmann, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Stein, Anja UNSPECIFIED UNSPECIFIED UNSPECIFIED
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:	Keywords Language REAL-TIME PCR; LATE-ONSET SEPSIS; STREAM INFECTIONS; MOLECULAR-DETECTION; DIAGNOSIS; DIFFERENTIATION; CULTURE Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26940