Abstract
BackgroundMolecular amplification techniques are suggested to be a useful adjunct in early detection of pathogens in septic patients. The aim was to study the feasibility of a polymerase chain reaction (PCR) assay compared to the standard microbiological culture (MC) technique in identification of pathogenic microorganisms from blood and non-blood samples in septic patients.MethodsSamples for pathogen identification were taken during febrile septic episodes (SE) in 54 patients with sepsis and analyzed using both MC and PCR. Semi-automated multiplex PCR, provided by Philips Medical Systems, was able to detect nine different pathogens. The accuracy of pathogen identification using PCR vs. MC as well as the time-saving effect of PCR on the potential decision-making process for antimicrobial therapy was evaluated.ResultsIn a total of 258 samples taken during 87 SE, both methods yielded more pathogens from the non-blood than blood samples (87 % vs. 45 %; p = 0.002). PCR identified more pathogens than MC in the blood samples (98 vs. 21; p < 0.0001), but not in other body fluids. In 35 SE, the potential decision on appropriate antimicrobial therapy based on PCR results could have been made 50 (median; interquartile range 35–87) hours earlier than decisions based on standard MC.ConclusionsIn septic patients, multiplex PCR identified more pathogenic microorganisms isolated from the blood samples than the standard MC technique. In the non-blood samples, PCR was comparable to that of MC.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-015-0116-1) contains supplementary material, which is available to authorized users.
Highlights
Molecular amplification techniques are suggested to be a useful adjunct in early detection of pathogens in septic patients
The anti-infective therapy of septic patients, which was initially started as empiric treatment according to current guidelines [15], was changed further only on the basis of the microbiological culture (MC) diagnostics; the results of the polymerase chain reaction (PCR) analysis were not disclosed to the attending physicians, so the results of PCR diagnostics did not influence the therapy of patients with sepsis, included in this investigation
During the diagnostics within these 35 septic episodes (SE), PCR was faster than MC in identification of pathogenic microorganisms: the potential time-saving effect of PCR was 50 hours (Additional file 3). In this prospective investigation, a multiplex PCR assay was feasible for the identification of pathogenic microorganisms along with the standard MC technique in patients with sepsis at the surgical intensive care unit
Summary
Molecular amplification techniques are suggested to be a useful adjunct in early detection of pathogens in septic patients. Sepsis is a common infectious cause of morbidity, requiring intensive care measures and immediate effective antimicrobial therapy. Mortality rates range from 10 to 20 % in patients with uncomplicated sepsis and up to 80 % in patients with septic shock [1], ranking sepsis as the most common cause of death in non-cardiac intensive care units [2]. Sepsis diagnostics using microbiological culture is possible only with viable pathogens. Their growth time requires up to 48 h to yield the final result, which may be negative in up to 30 % of cases [7, 8].
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