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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Rapid diagnosis of infection in the critically ill, a multicenter study of molecular detection in bloodstream infections, pneumonia, and sterile site infections
Critical Care Medicine, Volume 43, No. 11, Year 2015
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Description
Objective: Early identification of causative microorganism(s) in patients with severe infection is crucial to optimize antimicrobial use and patient survival. However, current culture-based pathogen identification is slow and unreliable such that broad-spectrum antibiotics are often used to insure coverage of all potential organisms, carrying risks of overtreatment, toxicity, and selection of multidrug-resistant bacteria. We compared the results obtained using a novel, culture-independent polymerase chain reaction/electrospray ionization-mass spectrometry technology with those obtained by standard microbiological testing and evaluated the potential clinical implications of this technique. Design: Observational study. Setting: Nine ICUs in six European countries. Patients: Patients admitted between October 2013 and June 2014 with suspected or proven bloodstream infection, pneumonia, or sterile fluid and tissue infection were considered for inclusion. Interventions: None. Measurements and Main Results: We tested 616 bloodstream infection, 185 pneumonia, and 110 sterile fluid and tissue specimens from 529 patients. From the 616 bloodstream infection samples, polymerase chain reaction/electrospray ionization-mass spectrometry identified a pathogen in 228 cases (37%) and culture in just 68 (11%). Culture was positive and polymerase chain reaction/electrospray ionization-mass spectrometry negative in 13 cases, and both were negative in 384 cases, giving polymerase chain reaction/electrospray ionization-mass spectrometry a sensitivity of 81%, specificity of 69%, and negative predictive value of 97% at 6 hours from sample acquisition. The distribution of organisms was similar with both techniques. Similar observations were made for pneumonia and sterile fluid and tissue specimens. Independent clinical analysis of results suggested that polymerase chain reaction/electrospray ionization-mass spectrometry technology could potentially have resulted in altered treatment in up to 57% of patients. Conclusions: Polymerase chain reaction/electrospray ionizationmass spectrometry provides rapid pathogen identification in critically ill patients. The ability to rule out infection within 6 hours has potential clinical and economic benefits. © 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Authors & Co-Authors
Vincent, Jean Louis
Belgium, Brussels
Université Libre de Bruxelles
Zacharowski, Kai D.
Germany, Frankfurt am Main
Universitätsklinikum Frankfurt
Mikaszewska-Sokolewicz, Małgorzata Anna
Poland, Warsaw
Medical University of Warsaw
Schrenzel, Jacques
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Simon, Franćois
France, Paris
Hôpital Saint-louis
Wilks, Mark
United Kingdom, London
Queen Mary University of London
Ecker, David J.
United States, Chicago
Abbott Laboratories
Sampath, Rangarajan
United States, Chicago
Abbott Laboratories
Singer, Mervyn
United Kingdom, London
University College London
Lelubre, Christophe
Belgium, Brussels
Hôpital Erasme
Peigne, Vincent
Unknown Affiliation
Pugin, Jéròme
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Meybohm, Patrick
Germany, Frankfurt am Main
Universitätsklinikum Frankfurt
Millar, Michael Ronald
United Kingdom, London
The Royal London Hospital
Delarue, Séverine Mercier
France, Paris
Hôpital Saint-louis
Minier, Marine
France, Paris
Hôpital Saint-louis
Shankar-Hari, Manu
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Statistics
Citations: 147
Authors: 17
Affiliations: 19
Identifiers
Doi:
10.1097/CCM.0000000000001249
ISSN:
00903493
Research Areas
Health System And Policy