Fuursted Kurt, Arpi Magnus, Lindblad Bent Erling, Pedersen Lisbeth Nørum
Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark.
Scand J Infect Dis. 2008;40(10):772-7. doi: 10.1080/00365540802119994.
We aimed to evaluate broad-range PCR and subsequent sequencing compared to conventional culture in the diagnosis of spinal infection. The method was a prospective study of all patients admitted to Aarhus University Hospital for surgery during a 12-months period with a clinically diagnosed infection of the spine. Samples from patients undergoing surgery for non-infectious causes (malignancy etc.) were included as control group. Specimens were submitted to conventional culture and molecular investigation with 16S rRNA gene amplification and sequence analysis. 38 patients were included in the study (clinically diagnosed spinal infections=18; non-infectious diseases=20). The specificity was excellent for both culture and PCR (95% and 100%, respectively). A true culture positive result was obtained in 50% of patients (9/18) and 61% was positive (11/18) by broad-range PCR. When combined, culture and PCR allowed for a microbiological diagnosis in 72% of patients (13/18). A positive culture was found only in patients treated < or =7 d compared to < or =16 d for PCR. However, PCR and culture result were equally negatively affected by duration of treatment. The combination of culture and broad-range PCR substantially adds to the number of microbiological diagnoses obtained, and improves the clinician's opportunity to tailor therapy to individual patients.
我们旨在评估与传统培养法相比，广谱聚合酶链反应（PCR）及后续测序在脊柱感染诊断中的应用。方法是对奥胡斯大学医院12个月期间因临床诊断为脊柱感染而入院接受手术的所有患者进行前瞻性研究。将因非感染性原因（恶性肿瘤等）接受手术患者的样本作为对照组。样本进行传统培养以及采用16S rRNA基因扩增和序列分析进行分子检测。38例患者纳入研究（临床诊断脊柱感染患者18例；非感染性疾病患者20例）。培养法和PCR的特异性均极佳（分别为95%和100%）。50%的患者（9/18）培养结果呈真阳性，广谱PCR检测61%呈阳性（11/18）。培养法和PCR联合使用时，72%的患者（13/18）可获得微生物学诊断结果。仅在治疗时间≤7天的患者中发现培养阳性，而PCR检测在治疗时间≤16天的患者中呈阳性。然而，PCR和培养结果均同样受到治疗时间的负面影响。培养法和广谱PCR联合使用显著增加了获得的微生物学诊断数量，并提高了临床医生针对个体患者制定治疗方案的机会。
