Molecular diagnosis of sepsis: New aspects and recent developments

Abstract

By shortening the time to pathogen identification and allowing for detection of organisms missed by blood culture, new molecular methods may provide clinical benefits for the management of patients with sepsis. While a number of reviews on the diagnosis of sepsis have recently been published we here present up-to-date new developments including multiplex PCR, mass spectrometry and array techniques. We focus on those techniques that are commercially available and for which clinical studies have been performed and published.

In vitro diagnosis of sepsis: a review

“…68 Enriched growth media, adsorbing agents to neutralize growth inhibitors, software for more rapid detection of microorganisms, and growth and advances in automated agitation systems represent recent laboratory improvements for detection of pathogens. 69,70 BC sensitivity for slow-growing and fastidious organisms can be poor, especially for bacteria that are responsible for community-acquired pneumonia, such as Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia pneumoniae, and for uncultivable pathogens, such as Francisella tularensis, Bartonella spp., Rickettsia spp., and Nocardia spp. 67,71 A further complication in interpreting a BC test result is the presence of contaminations; in fact, many efforts have been made to reduce contaminated BC through, for example, the use of sterile gloves or prepackaged BC kits.…”

“…77,79 The test specifically identifies 39 sepsis-related pathogens (32 bacterial species and seven fungal species) and five resistance genes such as the mecA, vanA/B, B-lactamase blaSHC, and blaCTX-M genes. 2,77,79 The main advantage of this PCR-based assay, compared to BC, is the turnaround (8 hours vs 1-3 days), 70,79 while the limitation is the number of pathogens that may be identified at the species level and the low specificity of the electrophoresisbased identification. 110 The VYOO ® assay has been used in a study in which 24 patients with severe sepsis and 22 with SIRS were examined.…”

“…70,137 The first involves amplification and sequencing of the first 527 bp fragment of the 16S rRNA genes of bacterial strains, 138 and the second has been used to classify and identify a variety of bacterial 16S rDNA fragments. 137 Currently, the next-generation sequencing (NGS) technology (eg, Illumina MiSeq) represents a new challenge to identify and genotype viable, dead, and viable but nonculturable pathogens, and antibiotic resistance markers, and it provides significant input to scientific discovery due to its cheap cost and fast turnaround.…”

Kadar 25-hydroxyvitamin D sebagai penanda sepsis pada anak

“…Untuk imunitas adaptif, vitamin D memengaruhi proliferasi dan diferensiasi sel T dan B serta memodulasi produksi imunoglobulin. 6,8,9 Di dalam tubuh manusia, 25- 1,13 Gizi kurang didefinisikan sebagai berat badan menurut panjang badan atau berat badan menurut tinggi badan antara -3 dan -2 skor-z grafik pertumbuhan WHO untuk anak berusia <5 tahun atau berat badan menurut tinggi badan antara 70% dan 90% grafik pertumbuhan CDC untuk anak berusia ≥5 tahun.…”

Antibiotic Use in Neonatal Intensive Care

“…New bacterial gene identification methods may enhance our use of standard blood cultures, particularly in excluding systemic infection. 15 More sophisticated approaches to identifying infants at risk for earlyonset sepsis by using a Bayesian approach could decrease empirical antibiotic treatment in as many as one-quarter million newborns nationwide. 16 Use of prophylactic antimicrobial agents (eg, fluconazole for prevention of candida sepsis) should be carefully considered and not serve as a replacement for other unit-based infection control strategies.…”