Lodes U, Meyer F, König B, Lippert H
Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Universitätsklinikum Magdeburg AöR, Magdeburg, Deutschland.
Zentralbl Chir. 2009 Jun;134(3):249-53. doi: 10.1055/s-0028-1098776. Epub 2009 Jun 17.
An adequate approach to surgically induced sepsis needs an early and targeted antibiotic therapy in addition to focus sanitation. The PCR-based LightCycler Septifast test can detect 90 % of the sepsis-associated microoganisms (e. g., Gram-positive, Gram-negative bacteria, fungi) within only a few hours.
A systematic microbiological screening was performed using conventional cultures from blood, urine, drain material and tracheal secretions as well as with the culture-independent Septifast test (blood supplemented with EDTA) as a comparison in consecutive surgical patients on the intensive care unit within a defined time period.
Overall, 52 patients were enrolled in the investigation during the study period of 4 months. Out of overall 258 Septifast tests, 33 (12.8 %) were positive. Additional information on the microbial spectrum was achieved in 24 cases (72.2 %) when compared with the simultaneously performed conventional blood cultures; 32 (12.4 %) of 258 blood cultures were positive. If the frequent occurrence of coagulase-negative STAPHYLOCOCCUS (CNS) is classified as contamination, blood cultures resulted 10 times (31.3 %) in additional information compared with the Septifast test including the CNS in 20 cases (62.5 %). Except for Proteus mirabilis, this refers to microorganisms which are not in the analytical spectrum of the Septifast(R) test. A positive Septifast test showed a high coincidence with SIRS (75.8 %).
This first systematic use of the time-saving LightCycler Septifast test shows that it can detect bacteremia in surgical patients at the ICU, with, in part, negative blood cultures. Positive Septifast test results which cannot be explained by clinical symptoms, occur rarely. The detection of pathological microbes with the Septifast test provides additional findings (72.2 %) for therapeutic decision-making, which can be obtained considerably more rapidly in comparison with conventional microbiological cultures (a few hours versus 2 days). For surgical patients with SIRS and subsequent need of intensive care, a Septifast test should be considered. In conclusion, it is recommended that the test should be further and systematically investigated.
对于外科手术引起的败血症，除了进行病灶清理外，还需要早期且有针对性的抗生素治疗。基于聚合酶链反应（PCR）的LightCycler Septifast检测能够在短短数小时内检测出90%的与败血症相关的微生物（如革兰氏阳性菌、革兰氏阴性菌、真菌）。
在规定时间段内，对重症监护病房的连续手术患者，采用来自血液、尿液、引流物及气管分泌物的传统培养方法以及与培养无关的Septifast检测（添加乙二胺四乙酸（EDTA）的血液）进行系统的微生物学筛查，并进行比较。
在为期4个月的研究期间，共有52例患者纳入调查。在总共258次Septifast检测中，33次（12.8%）呈阳性。与同时进行的传统血培养相比，24例（72.2%）获得了关于微生物谱的更多信息；258次血培养中有32次（12.4%）呈阳性。如果将凝固酶阴性葡萄球菌（CNS）的频繁出现归类为污染，与包括20例（62.5%）CNS的Septifast检测相比，血培养在10次（31.3%）检测中获得了更多信息。除奇异变形杆菌外，这指的是不在Septifast检测分析范围内的微生物。Septifast检测呈阳性与全身炎症反应综合征（SIRS）高度吻合（75.8%）。
首次对省时的LightCycler Septifast检测进行系统应用表明，它能够在重症监护病房的手术患者中检测出血菌血症，部分血培养结果为阴性。无法用临床症状解释的Septifast检测阳性结果很少出现。Septifast检测对病理性微生物的检测为治疗决策提供了更多发现（72.2%），与传统微生物培养相比（数小时对2天），能更快获得这些结果。对于患有SIRS且随后需要重症监护的手术患者，应考虑进行Septifast检测。总之，建议对该检测进行进一步系统研究。
