Abstract
BackgroundBlood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. LightCycler SeptiFast (LC-SF) is a real-time multiplex polymerase chain reaction test able to detect 25 common pathogens responsible for bloodstream infections within hours. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies.MethodRelated literature on Medline, Embase, and Cochrane databases was searched up to October 2012 for studies utilizing LC-SF to diagnose suspected sepsis and that provided sufficient data to construct two-by-two tables.ResultsA total of 34 studies enrolling 6012 patients of suspected sepsis were included. The overall sensitivity and specificity for LC-SF to detect bacteremia or fungemia was 0·75 (95% CI: 0·65–0·83) and 0·92 (95%CI:0·90–0·95), respectively. LC-SF had a high positive likelihood ratio (10·10) and a moderate negative likelihood ratio (0·27). Specifically, LC-SF had a sensitivity of 0·80 (95%CI: 0·70–0·88) and a specificity of 0·95(95%CI: 0·93–0·97) for the bacteremia outcome, and a sensitivity of 0·61 (95%CI: 0·48–0·72) and a specificity of 0·99 (95%CI: 0·99–0·99) for the fungemia outcome. High heterogeneity was found in the bacteremia outcome subgroup but not in the fungemia outcome subgroup.ConclusionLC-SF is of high rule-in value for early detection of septic patients. In a population with low pretest probability, LC-SF test can still provide valuable information for ruling out bacteremia or fungemia.
Highlights
The burden of sepsis is increasing globally
The overall sensitivity and specificity for LightCycler SeptiFast (LC-SF) to detect bacteremia or fungemia was 0?75 and 0?92 (95%CI:0?90–0?95), respectively
LC-SF had a sensitivity of 0?80 (95%CI: 0?70–0?88) and a specificity of 0?95(95%CI: 0?93–0?97) for the bacteremia outcome, and a sensitivity of 0?61 (95%CI: 0?48–0?72) and a specificity of 0?99 (95%CI: 0?99–0?99) for the fungemia outcome
Summary
A survey conducted in USA in 2000 revealed that there were more than 650 thousand of cases of sepsis annually, with an average mortality rate of 18% [1]. Another U.S report showed that the incidence of hospitalized patients with septicemia or sepsis had increased more than two folds in the last decade [2]. Blood culture has long been viewed as the gold standard test for the diagnosis of sepsis, it suffers from low sensitivity, prolonged turnaround time (.48 hours), and liability for contamination [6]. Blood culture is viewed as the golden standard for the diagnosis of sepsis but suffers from low sensitivity and long turnaround time. We aim to assess the accuracy of LC-SF by systematically reviewing the published studies
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