Infectious Agent Department, Parasitology-Mycology Laboratory, Albert Michallon Teaching Hospital, 38043 Grenoble Cedex 9, France.
J Infect. 2010 Oct;61(4):335-42. doi: 10.1016/j.jinf.2010.07.004. Epub 2010 Jul 15.
New molecular methods allow rapid pathogen detection in patients with sepsis, but their impact on treatment decisions remains to be established. We evaluated the therapeutic usefulness of multiplex PCR testing in patients with cancer and sepsis.
110 patients with cancer and sepsis were included prospectively and underwent LightCycler® SeptiFast (LC-SF) multiplex PCR testing in addition to standard tests. Two independent panels of experts assessed the diagnosis in each patient based on medical record data; only one panel had the LC-SF results. The final diagnosis established by a third panel was the reference standard.
The final diagnosis was documented sepsis in 50 patients (55 microorganisms), undocumented sepsis in 54, and non-infectious disease in 6. LC-SF detected 17/32 pathogens recovered from blood cultures (BC) and 11/23 pathogens not recovered from BC; 12 microorganisms were detected neither by BC nor by LC-SF. LC-SF produced false-positive results in 10 cases. The LC-SF results would have significantly improved treatment in 11 (10%) patients and prompted immediate antimicrobial therapy not given initially in 3 patients.
In cancer patients with suspected sepsis, LC-SF detected 11/55 (20%) true pathogens not recovered from BCs and would have improved the initial management in 11/110 (10%) patients.
新的分子方法可使败血症患者的病原体快速检测成为可能，但它们对治疗决策的影响仍有待确定。我们评估了多重 PCR 检测在癌症合并败血症患者中的治疗价值。
前瞻性纳入 110 例癌症合并败血症患者，除标准检测外，还进行 LightCycler® SeptiFast（LC-SF）多重 PCR 检测。两名独立的专家组根据病历数据对每位患者进行诊断评估；只有一组专家知道 LC-SF 结果。由第三专家组确定的最终诊断为参考标准。
最终诊断为 50 例（32 种病原体）有记录的败血症、54 例无记录的败血症和 6 例非传染性疾病。LC-SF 检测出血液培养物（BC）中 17/32 种回收病原体和 BC 中未回收的 11/23 种病原体；12 种微生物既未被 BC 也未被 LC-SF 检测到。LC-SF 在 10 例中产生了假阳性结果。LC-SF 结果将显著改善 11 例（10%）患者的治疗，并促使 3 例患者立即给予最初未给予的抗菌治疗。
在疑似败血症的癌症患者中，LC-SF 检测出 11/55（20%）未从 BC 中回收的真正病原体，并将改善 11/110（10%）患者的初始治疗。
