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Improved detection of blood stream pathogens by real-time PCR in severe sepsis

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Abstract

Objective

Evaluation of the technical and diagnostic feasibility of commercial multiplex real-time polymerase chain reaction (PCR) for detection of blood stream infections in a cohort of intensive care unit (ICU) patients with severe sepsis, performed in addition to conventional blood cultures.

Design

Dual-center cohort study.

Setting

Surgical ICU of two university hospitals.

Patients and participants

One hundred eight critically ill patients fulfilling the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) severe sepsis criteria were included.

Interventions

None.

Measurements and results

PCR results obtained in 453 blood samples from 108 patients were compared with corresponding blood culture results. PCR resulted in a twofold higher positivity rate when compared with conventional blood culture (BC) testing (114 versus 58 positive samples). In 40 out of 58 PCR positive assays the results of the corresponding blood cultures were identical to microorganisms detected by PCR. In 18 samples PCR and BC yielded discrepant results. Compared with conventional blood culture the sensitivity and specificity of PCR was 0.69 and 0.81, respectively. Further evaluation of PCR results against a constructed gold standard including conventional microbiological test results from other significant patient specimen (such as bronchio-alveolar lavage fluid, urine, swabs) and additionally generated clinical and laboratory information yielded sensitivity of 0.83 and specificity of 0.93.

Conclusions

Our cohort study demonstrates improved pathogen detection using PCR findings in addition to conventional blood culture testing. PCR testing provides increased sensitivity of blood stream infection. Studies addressing utility including therapeutic decision-making, outcome, and cost-benefit following diagnostic application of PCR tests are needed to further assess its value in the clinical setting.

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Acknowledgments

Rebecca Rödel and Sabine Mering provided expert technical assistance.

Conflict of interest statement

The authors have no competing interests. The authors, however, received research funding, reagents, and equipment from Roche Diagnostics GmbH for this project.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesie und Operative Intensivmedizin, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Lutz Eric Lehmann & Andreas Hoeft

  2. Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Frankfurt am Main, Paul-Ehrlich Str. 40, 60596, Frankfurt, Germany

    Klaus-Peter Hunfeld, Martina Steinbrucker & Volker Brade

  3. Zentralinstitut für Laboratoriumsmedizin, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany

    Klaus-Peter Hunfeld

  4. Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Goldenfelsstr. 19-21, 50935, Cologne, Germany

    Harald Seifert

  5. Zentrum der Anästhesiologie und Wiederbelebung, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany

    Tobias Bingold & Heimo Wissing

  6. Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, 3010, Bern, Switzerland

    Lutz Eric Lehmann, Malte Book & Frank Stüber

Authors
  1. Lutz Eric Lehmann
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  2. Klaus-Peter Hunfeld
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  3. Martina Steinbrucker
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  4. Volker Brade
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  5. Malte Book
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  6. Harald Seifert
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  7. Tobias Bingold
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  8. Andreas Hoeft
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  9. Heimo Wissing
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  10. Frank Stüber
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Corresponding author

Correspondence to Lutz Eric Lehmann.

Additional information

L. E. Lehmann and K-P. Hunfeld contributed equally to the work.

H. Wissing and F. Stüber conceived equally as senior authors of the study.

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Lehmann, L.E., Hunfeld, KP., Steinbrucker, M. et al. Improved detection of blood stream pathogens by real-time PCR in severe sepsis. Intensive Care Med 36, 49–56 (2010). https://doi.org/10.1007/s00134-009-1608-z

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  • DOI: https://doi.org/10.1007/s00134-009-1608-z

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