Impact of multiplex PCR on antimicrobial treatment in febrile neutropenia: a randomized controlled study

Abstract

Multiplex PCR (mPCR) directly from blood has been suggested as a promising method for rapid identification of pathogens causing sepsis. This study aimed to investigate whether mPCR has any impact on antimicrobial treatment. Hematological patients with febrile neutropenia were randomized into two groups. In the study group, mPCR was performed as an addition to standard diagnostics, and PCR finding was immediately communicated to the clinicians, thus being available for decision making. In the control group, clinicians were not aware of PCR result. PCR samples were collected simultaneously with clinically indicated blood culture specimens from peripheral vein and/or central venous catheter at fever onset and once again if fever persisted up to 72 h. Overall, 74 patients of the study group and 76 patients of the control group were enrolled and 253 samples collected. Therapy was changed to targeted antimicrobial therapy (AMT) in 12 patients (16.2%) in the study group and in 12 patients (15.8%) in the control group. For patients with changes, the median time to change to the targeted AMT was 21.4 h in the study group and 47.5 h in the control group (p = 0.018). In the study group, 57.1% (8/14) of changes to targeted AMT was due to PCR finding. PCR led to AMT change in 9.5% (7/74) of study group patients, i.e., in 33.3% (7/21) of patients who had positive PCR finding. There were no significant differences in patient outcomes (secondary endpoints). In conclusion, PCR method accelerates change to the targeted AMT in febrile neutropenic patients.

Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi – a systematic review and economic evaluation

“…45,69,[71][72][73][74][75][76][77][78][80][81][82][83][85][86][87][90][91][92][93][94][96][97][98][99][101][102][103]107,[109][110][111][112]114 Of these, nine studies reported blood volumes that did not comply with CE approval: Lehmann et al, 76 Lodes et al 92 and von Lilienfeld-Toal et al 71 all reported using 1 ml in adults; Bloos et al, 74 Lamoth et al, 75 Paolucci et al 99 and Sitnik et al 107 all reported using 3 ml in adults; Berger et al…”

“…community, emergency department, hospital, intensive/critical care, general/ specialist) was not reported for nine SeptiFast studies, 44,65,69,72,88,98,100,105,110 or for one multitest SeptiFast and SepsiTest study 118 (confidential information has been removed). The setting across the remaining studies varied (see Table 4).…”

“…The setting across the remaining studies varied (see Table 4). Explicit inclusion and exclusion criteria for patients were reported for seven SeptiFast studies, 74,80,83,106,[110][111][112] (confidential information has been removed) and one IRIDICA study. 116 With the exception of the SeptiFast study by Warhurst et al, 111 which reported on health-care-associated bloodstream infections, and the SeptiFast study by Josefson et al, 85 which reported on community-acquired bloodstream infections, reporting of whether infection was community or hospital acquired was unclear in the remainder of the included studies.…”

“…Across the remaining SeptiFast studies, 19 reported using the BACTEC system. 60,64,70,71,75,76,79,83,[85][86][87][92][93][94][95][96]107,110,112 Of these, one used the BACTEC system with MALDI-TOF MS. 112 Seventeen studies reported using the BacT/ALERT system. 45 70,75,83,99,109 For the remainder of the studies evaluating SeptiFast against blood culture (with or without MALDI-TOF MS) the unit of analysis was samples.…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…56 Whether application of these diagnostic methods has a measurable impact on HCT patient outcomes remains to be elucidated. 57 Role of surveillance blood cultures A retrospective study of asymptomatic adult allo-HCT recipients with CVCs who had 6801 surveillance blood cultures performed showed surveillance cultures infrequently yielded significant results (0.59% of all surveillance blood cultures drawn) and were associated with unnecessary medical interventions and added cost. 58 A prospective observational study in allo-HCT recipients receiving steroids who underwent daily blood culture surveillance also did not demonstrate a clear benefit and rarely identified a CLABSI.…”