Multiplex Blood PCR in Combination with Blood Cultures for Improvement of Microbiological Documentation of Infection in Febrile Neutropenia

Lamoth, Frédéric; Jaton, Katia; Prod’hom, Guy; Senn, Laurence; Billé, Jacques; Calandra, Thierry; Marchetti, Oscar

doi:10.1128/jcm.00147-10

Cited by 105 publications

(84 citation statements)

References 43 publications

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“…This is comparable to the results of some earlier studies [26,27]. In studies performed in emergency departments, the rates of positivity were generally higher.…”

Section: Streptococcus Constellatussupporting

confidence: 89%

Comparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis patients

Schreiber

Nierhaus

Braune

et al. 2013

Med Klin Intensivmed Notfmed

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“…This is comparable to the results of some earlier studies [26,27]. In studies performed in emergency departments, the rates of positivity were generally higher.…”

Section: Streptococcus Constellatussupporting

confidence: 89%

Comparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis patients

Schreiber

Nierhaus

Braune

et al. 2013

Med Klin Intensivmed Notfmed

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“…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…”

Section: Details Of Index and Reference Tests Blood Sampling Methodsmentioning

confidence: 99%

“…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. Although the heterogeneity in the metrics has the potential to introduce some bias, the impact on the results was believed to be modest.…”

mentioning

confidence: 99%

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

Stevenson

Pandor

James

et al. 2016

Health Technol Assess

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BackgroundSepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity.ObjectivesTo determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE®(Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTestTM(Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-of-flight mass spectrometry).Data sourcesThirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles.Review methodsA systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty.ResultsFor the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based.LimitationsRobust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable.ConclusionsThe clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required.Study registrationThis study is registered as PROSPERO CRD42015016724.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Since their sensitivity is significantly lower once antibiotic therapy has been started, they should be performed immediately when infection during neutropenia is suspected. 120 Hopefully, novel diagnostic methods, mostly based on Polymerase Chain Reaction (PCR) systems, will improve the yield of blood cultures, particularly if drawn after the onset of antibiotic therapy, such as in case of persistent fever, and will result in shorter time to microbiological diagnosis. 120 Furthermore the combination of nucleic acids amplification with mass spectrometry could permit obtaining the results within 6 hours, but no data are so far available in hematology or oncology settings.…”

Section: Diagnosismentioning

confidence: 99%

“…120 Hopefully, novel diagnostic methods, mostly based on Polymerase Chain Reaction (PCR) systems, will improve the yield of blood cultures, particularly if drawn after the onset of antibiotic therapy, such as in case of persistent fever, and will result in shorter time to microbiological diagnosis. 120 Furthermore the combination of nucleic acids amplification with mass spectrometry could permit obtaining the results within 6 hours, but no data are so far available in hematology or oncology settings. 121 In non-neutropenic patients, procalcitonin (PCT) is used as an early serum marker of inflammation (it increases within 3 hours from infection, compared to 24 hours for C-reactive protein, CRP), as it has over 90% sensitivity and specificity for bacterial BSI.…”

Section: Diagnosismentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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Multiplex Blood PCR in Combination with Blood Cultures for Improvement of Microbiological Documentation of Infection in Febrile Neutropenia

Cited by 105 publications

References 43 publications

Comparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis patients

Comparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis 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

Bloodstream infections in neutropenic cancer patients: A practical update

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