Multiplex PCR To Diagnose Bloodstream Infections in Patients Admitted from the Emergency Department with Sepsis

Author:

Tsalik Ephraim L.1,Jones Daphne2,Nicholson Bradly2,Waring Lynette3,Liesenfeld Oliver3,Park Lawrence P.1,Glickman Seth W.4,Caram Lauren B.1,Langley Raymond J.5,van Velkinburgh Jennifer C.5,Cairns Charles B.4,Rivers Emanuel P.6,Otero Ronny M.6,Kingsmore Stephen F.5,Lalani Tahaniyat7,Fowler Vance G.1,Woods Christopher W.1

Affiliation:

1. Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina

2. Department of Medicine, Durham VA Medical Center, Durham, North Carolina

3. Roche Molecular Diagnostics, Pleasanton, California

4. Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina

5. National Center for Genome Resources, Santa Fe, New Mexico

6. Henry Ford Hospital, Wayne State University, Detroit, Michigan

7. Naval Medical Center Portsmouth, Portsmouth, Virginia

Abstract

ABSTRACT Sepsis is caused by a heterogeneous group of infectious etiologies. Early diagnosis and the provision of appropriate antimicrobial therapy correlate with positive clinical outcomes. Current microbiological techniques are limited in their diagnostic capacities and timeliness. Multiplex PCR has the potential to rapidly identify bloodstream infections and fill this diagnostic gap. We identified patients from two large academic hospital emergency departments with suspected sepsis. The results of a multiplex PCR that could detect 25 bacterial and fungal pathogens were compared to those of blood culture. The results were analyzed with respect to the likelihood of infection, sepsis severity, the site of infection, and the effect of prior antibiotic therapy. We enrolled 306 subjects with suspected sepsis. Of these, 43 were later determined not to have infectious etiologies. Of the remaining 263 subjects, 70% had sepsis, 16% had severe sepsis, and 14% had septic shock. The majority had a definite infection (41.5%) or a probable infection (30.7%). Blood culture and PCR performed similarly with samples from patients with clinically defined infections (areas under the receiver operating characteristic curves, 0.64 and 0.60, respectively). However, blood culture identified more cases of septicemia than PCR among patients with an identified infectious etiology (66 and 46, respectively; P = 0.0004). The two tests performed similarly when the results were stratified by sepsis severity or infection site. Blood culture tended to detect infections more frequently among patients who had previously received antibiotics ( P = 0.06). Conversely, PCR identified an additional 24 organisms that blood culture failed to detect. Real-time multiplex PCR has the potential to serve as an adjunct to conventional blood culture, adding diagnostic yield and shortening the time to pathogen identification.

Publisher

American Society for Microbiology

Subject

Microbiology (medical)

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