Potential clinical utility of polymerase chain reaction in microbiological testing for sepsis

Abstract

Rapid PCR identification of microorganisms may contribute to a reduction of early inadequate antibiotic treatment in sepsis.

Microbiological Diagnosis of Sepsis: Polymerase Chain Reaction System Versus Blood Cultures

“…However, on the whole, the results are consistent with those reported by other investigators, [8][9][10][11]21,22,28 suggesting that these findings may be extrapolated to other populations. Finally, the variability of the number of blood culture sets collected and the high rate of patients with only 2 bottles of blood samples for culture obtained could have influenced the sensitivity of the technique.…”

“…SeptiFast detects the microorganism responsible for bloodstream infections significantly earlier than blood cultures in different clinical settings, 23 and its use has yielded a significant increase in gained treatment days. 28 Increased costs derived from performing the test in real time could be recouped, as SeptiFast would improve the quality of patients' treatment, reducing the number of resources needed for longer ICU and hospital stays, and the costs of antibiotic treatment. 29,30 Despite the recommendations from the Surviving Sepsis Campaign about obtaining blood samples for culture before starting treatment with broad-spectrum antibiotics, 31 many clinicians still postpone bacteriological diagnostic tests.…”

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

“…In contrast, none of the three PCR assays identified coagulase-negative staphylococci as a result of contamination. This higher contamination rate of blood cultures compared to the PCR assays is in line with other studies [28,30]. The phenomenon of higher rates of false positives in blood cultures is explained by the higher levels of bacterial DNA or frequent contaminants such as coagulase-negative staphylococci that are required for detection in PCR assays [9,31].…”

Potential Clinical Usefulness of the Polymerase Chain Reaction Test to Detect Pathogens Causing Sepsis

“…This method is designed to detect bacteria and fungi in whole blood by the amplification of their nucleic acids within 5 hours, which would make it possible to obtain information on bacteremia and fungemia quite earlier than that which could be obtained from BC. The higher sensitivity of this method compared with BC is reported in many recent studies [6,7,8]; however, the interpretation of positive PCR test results was not consistent, especially when BC results were negative [17]. In their multicenter trial to compare PCR test and BC, Bloos et al [10] reported 34.7% positive results with the PCR test in comparison with 16.5% positive results for BC in severe sepsis.…”

“…To date, significantly higher positive results from the PCR test than BC have been shown in multiple trials targeting sepsis [6,7,8]; however, antibiotic resistance determinants or interpretation of false-positive PCR tests are the major limitations preventing wide clinical use of this method. In their review in 2011, Pletz et al [9] discussed the clinical advantages and cost effectiveness of PCR testing and stated that the PCR test should focus on those pathogens or resistance determinants that are not covered by guideline-recommended treatment regimens and that have been identified as the major cause of inappropriate treatment according to current studies: Candida ssp., Aspergillus spp., methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococci, and extended-spectrum beta-lactamase and carbapenemase-positive Gram-negative microorganisms.…”