Lehmann Lutz Eric, Alvarez Julian, Hunfeld Klaus-Peter, Goglio Antonio, Kost Gerald J, Louie Richard F, Raglio Annibale, Regueiro Benito J, Wissing Heimo, Stüber Frank
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany.
Crit Care Med. 2009 Dec;37(12):3085-90. doi: 10.1097/CCM.0b013e3181b033d7.
To evaluate the potential improvement of antimicrobial treatment by utilizing a new multiplex polymerase chain reaction (PCR) assay that identifies sepsis-relevant microorganisms in blood.
Prospective, observational international multicentered trial.
University hospitals in Germany (n = 2), Spain (n = 1), and the United States (n = 1), and one Italian tertiary general hospital.
436 sepsis patients with 467 episodes of antimicrobial treatment.
Whole blood for PCR and blood culture (BC) analysis was sampled independently for each episode. The potential impact of reporting microorganisms by PCR on adequacy and timeliness of antimicrobial therapy was analyzed. The number of gainable days on early adequate antimicrobial treatment attributable to PCR findings was assessed.
Sepsis criteria, days on antimicrobial therapy, antimicrobial substances administered, and microorganisms identified by PCR and BC susceptibility tests.
BC diagnosed 117 clinically relevant microorganisms; PCR identified 154. Ninety-nine episodes were BC positive (BC+); 131 episodes were PCR positive (PCR+). Overall, 127.8 days of clinically inadequate empirical antibiotic treatment in the 99 BC+ episodes were observed. Utilization of PCR-aided diagnostics calculates to a potential reduction of 106.5 clinically inadequate treatment days. The ratio of gainable early adequate treatment days to number of PCR tests done is 22.8 days/100 tests overall (confidence interval 15-31) and 36.4 days/100 tests in the intensive care and surgical ward populations (confidence interval 22-51).
Rapid PCR identification of microorganisms may contribute to a reduction of early inadequate antibiotic treatment in sepsis.
利用一种新的多重聚合酶链反应（PCR）检测法来鉴定血液中与脓毒症相关的微生物，以评估抗菌治疗的潜在改善情况。
前瞻性、观察性国际多中心试验。
德国的大学医院（2家）、西班牙的大学医院（1家）、美国的大学医院（1家）以及一家意大利三级综合医院。
436例脓毒症患者，共进行了467次抗菌治疗。
每次治疗时独立采集用于PCR和血培养（BC）分析的全血。分析通过PCR报告微生物对抗菌治疗的充分性和及时性的潜在影响。评估因PCR结果而在早期充分抗菌治疗上可获得的天数。
脓毒症标准、抗菌治疗天数、使用的抗菌物质以及通过PCR和BC药敏试验鉴定出的微生物。
BC诊断出117种临床相关微生物；PCR鉴定出154种。99次治疗血培养呈阳性（BC+）；131次治疗PCR呈阳性（PCR+）。总体而言，在99次BC+治疗中观察到127.8天的临床经验性抗生素治疗不足。利用PCR辅助诊断预计可减少106.5天的临床治疗不足天数。早期充分治疗可获得的天数与所做PCR检测次数的总体比率为22.8天/100次检测（置信区间15 - 31），在重症监护病房和外科病房人群中为36.4天/100次检测（置信区间22 - 51）。
微生物的快速PCR鉴定可能有助于减少脓毒症早期抗生素治疗不足的情况。
