Detección automática de bacterias y hongos en sangre

Molina, J M; Córdoba, Juan Pablo; Ramírez, Paula; Gobernado, M

doi:10.1016/s0213-005x(08)76544-3

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…Initially, the LightCycler SeptiFast® was designed to identify rapidly the most important microorganisms responsible for bacteraemia in patients with hematological malignancies [ 9 ],[ 10 ] or cancer [ 11 ], especially during febrile neutropenia [ 12 ]. This technique was evaluated using blood samples of patients admitted to the ICU [ 13 ], emergency units [ 14 ], or ward [ 15 ],[ 16 ]. These studies have shown that MPCR can be simultaneously used with blood culture-based methods in order to improve pathogen identification rate in patients who had received antimicrobials.…”

Section: Introductionmentioning

confidence: 99%

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study

Baudel

Tankovic

Dahoumane

et al. 2014

Ann. Intensive Care

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BackgroundIn critically ill patients with pneumonia, accurate microorganism identification allows appropriate antibiotic treatment. In patients undergoing bronchoalveolar lavage (BAL), direct examination of the fluid using Gram staining provides prompt information but pathogen identification accuracy is low. Culture of BAL fluid is actually the reference, but it is not available before 24 to 48 h. In addition, pathogen identification rate observed with direct examination and culture is decreased when antibiotic therapy has been given prior to sampling. We therefore assessed, in critically ill patients with suspected pneumonia, the performance of a multiplex PCR (MPCR) to identify pathogens in BAL fluid. This study is a prospective pilot observation.MethodsWe used a MPCR detecting 20 types of microorganisms. Direct examination, culture, and MPCR were performed on BAL fluid of critically ill patients with pneumonia suspicion. The final diagnosis of infective pneumonia was retained after the medical chart was reviewed by two experts. Pathogen identification rate of direct examination, culture, and MPCR in patients with confirmed pneumonia was compared.ResultsAmong the 65 patients with pneumonia suspicion, the diagnosis of pneumonia was finally retained in 53 cases. Twenty nine (55%) were community-acquired pneumonia and 24 (45%) were hospital acquired. Pathogen identification rate with MPCR (66%) was greater than with culture (40%) and direct examination (23%) (p =0.01 and p <0.001, respectively). When considering only the microorganisms included in the MPCR panel, the pathogen identification rate provided by MPCR reached 82% and was still higher than with culture (35%, p <0.001) and direct examination (21%, p <0.001). Pathogen identification rate provided by MPCR was not modified in the case of previous antibiotic treatment (66% vs. 64%, NS) and was still better than with culture (23%, p <0.001).ConclusionsThe results of this pilot study suggest that in critically ill patients, MPCR performed on BAL fluid could provide higher identification rate of pathogens involved in pneumonia than direct examination and culture, especially in patients having received antimicrobial treatment.

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Section: Introductionmentioning

confidence: 99%

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study

Baudel

Tankovic

Dahoumane

et al. 2014

Ann. Intensive Care

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“…All adult patients (> 18 years old) admitted to the Sao Paulo Heart Institute for at least 48 h and with a diagnosis of sepsis according to the International Sepsis Definitions Conference were assessed for eligibility [10]. Exclusion occurred with at least one of the following criteria: cardiac surgery with cardiopulmonary bypass (CPB) in the last 15 days, use of intravenous heparin (due to the substantial inhibition of internal controls in Gram-negative bacilli), palliative care, and participation in other interventional studies [8, 10]. Written informed consent was obtained from all patients by a member of the local research team.…”

Section: Methodsmentioning

confidence: 99%

“…However, this method has several limitations, such as lack of rapidity and low sensitivity in case of prior antibiotic exposure, and when fastidious microorganisms are involved. These limitations result in delayed appropriate antibiotic therapy, prolonged use of broad-spectrum antimicrobial therapy, and changes in the host microbiome, thus facilitating the development of opportunistic infections and increasing selective pressure for antibiotic-resistant pathogens [6–8]. As appropriateness and timing of empirical antimicrobial therapy is essential to improve outcomes in sepsis, a faster pathogen detection would be desirable.…”

Section: Introductionmentioning

confidence: 99%

The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

et al. 2019

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Background Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test—Septi Fast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012–May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071–2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357–2563) DOT/1000 patients-day in the control group ( p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h— p < 0.001), in the duration of antimicrobial therapy ( p = 0.039) and in anti-gram-positive antimicrobial costs ( p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC ( p = 0.45). Conclusion This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of Septi Fast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. Trial registration The trial was registered at ClinicalTrials.gov ( NCT 01450358 ) on 12th October 2011 Electronic supplementary material The online version of this article (10.1186/s40560-019-0391-3) contains supplementary material, which is available to authorized users.

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“…[41][42][43] During the course of the current National Institute for Health Research (NIHR) HTA trial, further studies investigating the diagnostic performance of LightCycler SeptiFast technology have been published, predominantly focusing on suspected sepsis. None of studies to date has specifically examined the performance of the test in the context of suspected health-care-associated bloodstream infection, which is the focus of the current study.…”

Section: Lightcycler Septifast Real-time Polymerase Chain Reactionmentioning

confidence: 99%

Rapid detection of health-care-associated bloodstream infection in critical care using multipathogen real-time polymerase chain reaction technology: a diagnostic accuracy study and systematic review

Warhurst

Dunn

Chadwick

et al. 2015

Health Technology Assessment

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BackgroundThere is growing interest in the potential utility of real-time polymerase chain reaction (PCR) in diagnosing bloodstream infection by detecting pathogen deoxyribonucleic acid (DNA) in blood samples within a few hours. SeptiFast (Roche Diagnostics GmBH, Mannheim, Germany) is a multipathogen probe-based system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection. As background to this study, we report a systematic review of Phase III diagnostic accuracy studies of SeptiFast, which reveals uncertainty about its likely clinical utility based on widespread evidence of deficiencies in study design and reporting with a high risk of bias.ObjectiveDetermine the accuracy of SeptiFast real-time PCR for the detection of health-care-associated bloodstream infection, against standard microbiological culture.DesignProspective multicentre Phase III clinical diagnostic accuracy study using the standards for the reporting of diagnostic accuracy studies criteria.SettingCritical care departments within NHS hospitals in the north-west of England.ParticipantsAdult patients requiring blood culture (BC) when developing new signs of systemic inflammation.Main outcome measuresSeptiFast real-time PCR results at species/genus level compared with microbiological culture in association with independent adjudication of infection. Metrics of diagnostic accuracy were derived including sensitivity, specificity, likelihood ratios and predictive values, with their 95% confidence intervals (CIs). Latent class analysis was used to explore the diagnostic performance of culture as a reference standard.ResultsOf 1006 new patient episodes of systemic inflammation in 853 patients, 922 (92%) met the inclusion criteria and provided sufficient information for analysis. Index test assay failure occurred on 69 (7%) occasions. Adult patients had been exposed to a median of 8 days (interquartile range 4–16 days) of hospital care, had high levels of organ support activities and recent antibiotic exposure. SeptiFast real-time PCR, when compared with culture-proven bloodstream infection at species/genus level, had better specificity (85.8%, 95% CI 83.3% to 88.1%) than sensitivity (50%, 95% CI 39.1% to 60.8%). When compared with pooled diagnostic metrics derived from our systematic review, our clinical study revealed lower test accuracy of SeptiFast real-time PCR, mainly as a result of low diagnostic sensitivity. There was a low prevalence of BC-proven pathogens in these patients (9.2%, 95% CI 7.4% to 11.2%) such that the post-test probabilities of both a positive (26.3%, 95% CI 19.8% to 33.7%) and a negative SeptiFast test (5.6%, 95% CI 4.1% to 7.4%) indicate the potential limitations of this technology in the diagnosis of bloodstream infection. However, latent class analysis indicates that BC has a low sensitivity, questioning its relevance as a reference test in this setting. Using this analysis approach, the sensitivity of the SeptiFast test was low but also appeared significantly better than BC. Blood samples identified as positive by either culture or SeptiFast real-time PCR were associated with a high probability (> 95%) of infection, indicating higher diagnostic rule-in utility than was apparent using conventional analyses of diagnostic accuracy.ConclusionSeptiFast real-time PCR on blood samples may have rapid rule-in utility for the diagnosis of health-care-associated bloodstream infection but the lack of sensitivity is a significant limiting factor. Innovations aimed at improved diagnostic sensitivity of real-time PCR in this setting are urgently required. Future work recommendations include technology developments to improve the efficiency of pathogen DNA extraction and the capacity to detect a much broader range of pathogens and drug resistance genes and the application of new statistical approaches able to more reliably assess test performance in situation where the reference standard (e.g. blood culture in the setting of high antimicrobial use) is prone to error.Study registrationThe systematic review is registered as PROSPERO CRD42011001289.FundingThe National Institute for Health Research Health Technology Assessment programme. Professor Daniel McAuley and Professor Gavin D Perkins contributed to the systematic review through their funded roles as codirectors of the Intensive Care Foundation (UK).

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Detección automática de bacterias y hongos en sangre

Cited by 12 publications

References 34 publications

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study

Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: a pilot study

The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial

Rapid detection of health-care-associated bloodstream infection in critical care using multipathogen real-time polymerase chain reaction technology: a diagnostic accuracy study and systematic review

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