Abstract
Introduction
Early detection of the causing microorganism and timely therapeutic intervention are crucial for improved outcome of patients with sepsis. Quite recently, we evaluated the technical and diagnostic feasibility of a commercial multiplex real-time polymerase chain reaction (PCR) (LightCycler SeptiFast® assay) for detection of blood stream infections in a cohort of intensive care unit (ICU) patients with the risk of abdominal sepsis.
Results and findings
The PCR positivity rate showed a high coincidence with systemic inflammatory response syndrome (SIRS; 75.8%). In this study, we focussed on patients from the same surgical ICU with upcoming SIRS and addressed the utility on therapeutic decision making following diagnostic application of PCR in addition and comparison to conventional microbiological and laboratory tests. In total, 104 patients on the ICU fulfilling the American College of Chest Physicians/Society of Critical Care Medicine SIRS criteria were enrolled. Blood samples were taken within 24 h of upcoming SIRS. Some 39.9% (n = 59) of the blood samples (n Total = 148) were positive using multiplex-PCR and 20.3% (n = 30) using conventional culture. In 11.4% of all samples, multiplex-PCR detected more than one microorganism. Among the 77 microorganisms identified by multiplex-PCR, only 25 (32.5%) could be confirmed by blood culture; an additional 17 could be confirmed by microbiological test results from other significant patient specimen. Positive blood samples independent of the detection method were characterised by significant elevated levels of procalcitonin (p < 0.05) but not C-reactive protein. In 25 cases (16.9%, n = 148), the rapid identification of involved pathogens by multiplex-PCR led to prompt adjustment of therapy.
Conclusions
Our study demonstrates improved detection of specific pathogens with a high intrinsic resistance and positive impact on therapeutic decision-making by additional multiplex-PCR-based analysis of blood samples for infectious agents in patients with new onset of SIRS. Thus, we showed for the first time that PCR test results guide clinical treatment successfully.
Similar content being viewed by others
References
Dombrovskiy VY, Martin AA, Sunderram J, Paz HL (2007) Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med 35:1244–1250
Brunkhorst FM, Engel C, Reinhart K, for the German Competence Network Sepsis (SepNet) et al (2005) Epidemiology of severe sepsis and septic shock in Germany—results from the German “Prevalence” Study. Crit Care 9(Suppl 1):83
De Waele JJ (2010) Early source control in sepsis. Langenbecks Arch Surg 395:489–494
Ibrahim EH, Sherman G, Ward S et al (2000) The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 118:146–155
Kollef MH, Sherman G, Ward S et al (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474
Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A et al (2003) Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 31:2742–2751
Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596
Vincent JL (2008) Clinical sepsis and septic shock—definition, diagnosis and management principles. Langenbecks Arch Surg 393:817–824
Bodmann KF, Grabein B, Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen–Update 2010. Chemother J 19:179–255
Reinhart K, Brunkhorst FM, Bone HG et al (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis. 1. Revision der S-2k Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Anaesthesist 59:347–370
Sandiumenge A, Diaz E, Bodi M, Rello J (2003) Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of “The Tarragona Strategy”. Int Care Med 29:876–883
Lehmann LE, Hunfeld KP, Emrich T et al (2008) A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples. Med Microbiol Immunol 197:313–324
Louie RF, Tang Z, Albertson TE et al (2008) Multiplex polymerase chain reaction detection enhancement of bacteremia and fungiemia. Crit Care Med 36(5):1487–1492
Ivančević N, Radenković D, Bumbaširević V et al (2008) Procalcitonin in preoperative diagnosis of abdominal sepsis. Langenbecks Arch Surg 393:397–403
Schroeder S, Hochreiter M, Koehler T et al (2009) Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg 394:221–226
Lodes U, Meyer F, König B, Lippert H (2009) Mikrobiologisches sepsis-screening chirurgischer Intensivpatienten mit dem “Lightcycler” Septifast®-Test—eine Pilotstudie. Zentralbl Chir 134(3):249–253
ACCP/SCCM Consensus Conference Committee (1992) Definition for sepsis and organ failure in guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
Seifert H (2001) MIQ: Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik Heft 3: Sepsis-Blutkulturdiagnostik. Elsevier, Urban&Fischer München
Mancini N, Clerici D, Diotti R et al (2008) Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies. J Med Microbiol 57(Pt 5):601–604
Casalta JP, Gouriet F, Roux V et al (2009) Evaluation of the LightCycler® SeptiFast test in the rapid etiologic diagnostic of infectious endocarditis. Eur J Clin Microbiol Infect Dis 28(6):569–573
Lehmann LE, Hunfeld KP, Steinbrucker M et al (2010) Improved detection of blood stream pathogens by real-time PCR in severe sepsis. Intensive Care Med 36(1):49–56
Kreger BE, Craven DE, McCabe WR (1980) Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344–355
Mancini N, Carletti S, Ghidoli N et al (2009) Molecular diagnosis of polymicrobial sepsis. J Clin Microbiol 47:1274–1275
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
F. Meyer and B. König contributed equally as senior authors of the study.
Rights and permissions
About this article
Cite this article
Lodes, U., Bohmeier, B., Lippert, H. et al. PCR-based rapid sepsis diagnosis effectively guides clinical treatment in patients with new onset of SIRS. Langenbecks Arch Surg 397, 447–455 (2012). https://doi.org/10.1007/s00423-011-0870-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-011-0870-z