Non-culture-based methods to diagnose bloodstream infection: Does it work?

Abstract

Bloodstream infections are a major cause of morbidity and mortality worldwide. Molecular methods for the detection of pathogens in blood have been developed. The clinical utility of these methods and their integration into the clinical workflow is discussed.

Diagnostic and prognostic value of sCD14-ST—presepsin for patients admitted to hospital intensive care unit (ICU)

“…CD64 index showed the highest diagnostic value of all bacterial infection biomarkers tested here with AUC of 0.826. An ideal biomarker for bloodstream infection should have a high-diagnostic accuracy especially in the early phase of bloodstream infection and should be able to monitor therapy successfulness [24]. The expression of CD64 receptors on neutrophils was significantly higher in patients with infection as it was concluded in meta-analysis of Cid et al [25].…”

“…PCT may also be elevated in patients with non-infectious disease conditions, e.g. burn patients, patients with severe trauma and patients with surgical invasive procedures [24]. It has been reported that a high concentration of plasma PCT was found in patients with severe infection, while PCT levels were very low in those with no infections [30].…”

Diagnostic accuracy of SeptiFast multi-pathogen real-time PCR in the setting of suspected healthcare-associated bloodstream infection

“…Molecular non-culture approaches based on the detection of circulating bacterial and/or fungal DNA by real-time PCR (RT-PCR) have the potential to provide rapid detection of pathogens in blood with higher sensitivity but, to date, they have not been widely adopted in healthcare settings [10,11]. SeptiFast, manufactured by Roche Diagnostics GmbH (Mannheim, Germany) was the first RT-PCR-based platform to be awarded a Conformité Européenne (CE) mark for simultaneous detection and identification of bloodstream pathogens [12].…”

Bacterial sepsis

“…However, molecular genetic techniques have only been able to identify a few resistance mechanisms to date [92]. Whether the shorter latency period between sample collection and results [93] propagated by the manufacturers of these products is realizable in clinical routine appears questionable. Since a eubacterial PCR with subsequent sequencing of the amplification product takes many hours, a clear time advantage of PCR-based pathogen diagnostics is primarily achievable when searching for defined pathogens or within a limited pathogen spectrum, e. g., when looking for Neisseria meningitidis and Listeria monocytogenes in patients with meningoencephalitis, or for viral infection diagnostics.…”

“…However, these methods are currently not routinely implemented [93]. The costs of these investigations are presently very high [101,102], which limits their use primarily to studies.…”