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A multicenter trial to compare blood culture with polymerase chain reaction in severe human sepsis

Intensive Care Medicine volume 36, pages 241–247 (2010)Cite this article

Abstract

Objective

To assess the presence of microbial DNA in the blood by polymerase chain reaction (PCR) and its association with disease severity and markers of inflammation in severe sepsis and to compare the performance of PCR with blood culture (BC).

Design

Prospective multicentric controlled observational study.

Setting

Three surgical intensive care units in university centers and large teaching hospitals.

Patients

One hundred forty-two patients with severe sepsis and 63 surgical controls.

Interventions

Presence of microbial DNA was assessed by multiplex PCR upon enrollment, and each time a BC was obtained.

Measurements and main results

Controls had both approximately 4% positive PCRs and BCs. In severe sepsis, 34.7% of PCRs were positive compared to 16.5% of BCs (P < 0.001). Consistently, 70.3% of BCs had a corresponding PCR result, while only 21.4% of PCR results were confirmed by BC. Compared to patients with negative PCRs at enrollment, those testing positive had higher organ dysfunction scores [SOFA, median (25th–75th percentile) 12 (7–15) vs. 9 (7–11); P = 0.023] and a trend toward higher mortality (PCR negative 25.3%; PCR positive 39.1%; P = 0.115).

Conclusions

In septic patients, concordance between BC and PCR is moderate. However, PCR-based pathogen detection correlated with disease severity even if the BC remained negative, suggesting that presence of microbial DNA in the bloodstream is a significant event. The clinical utility to facilitate treatment decisions warrants investigation.

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Acknowledgments

Financial support, study logistics and data management were provided by Roche Diagnostics. The protocol was written in collaboration with the sponsor, while interpretation, analysis and writing the manuscript were completely in the hands of the investigators.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Therapy, University Hospital Jena, Erlanger Allee 101, 07747, Jena, Germany

    Frank Bloos, Konrad Reinhart & Michael Bauer

  2. Department of Anesthesiology and Intensive Care Therapy, University Hospital Münster, Münster, Germany

    Frank Hinder

  3. Institute of Medical Microbiology, University Hospital Münster, Münster, Germany

    Karsten Becker & Georg Peters

  4. Department of Microbiology, University Hospital Jena, Jena, Germany

    Svea Sachse & Eberhard Straube

  5. Service de Reanimation Medicale, Hôpital Henri Mondor, Creteil Cedex, France

    Armand Mekontso Dessap & Christian Brun-Buisson

  6. Service de Bactériologie, Hôpital Henri Mondor, AP-HP, Creteil Cedex, France

    Vincent Cattoir

Authors
  1. Frank Bloos
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  2. Frank Hinder
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  3. Karsten Becker
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  4. Svea Sachse
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  5. Armand Mekontso Dessap
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  6. Eberhard Straube
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  7. Vincent Cattoir
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  8. Christian Brun-Buisson
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  9. Konrad Reinhart
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  10. Georg Peters
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  11. Michael Bauer
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Corresponding author

Correspondence to Michael Bauer.

Additional information

This article is discussed in the editorial available at:doi:10.1007/s00134-009-1710-2.

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Bloos, F., Hinder, F., Becker, K. et al. A multicenter trial to compare blood culture with polymerase chain reaction in severe human sepsis. Intensive Care Med 36, 241–247 (2010). https://doi.org/10.1007/s00134-009-1705-z

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  • DOI: https://doi.org/10.1007/s00134-009-1705-z

Keywords

  • Sepsis
  • Polymerase chain reaction
  • Bacteremia/diagnosis
  • Fungemia/diagnosis