Microbiology Service, Hospital Clínico Universitario, Av. Blasco Ibáñez 17, 46010 Valencia, Spain.
Int J Infect Dis. 2011 May;15(5):e326-31. doi: 10.1016/j.ijid.2011.01.003. Epub 2011 Feb 24.
The objectives of this study were to compare the performance of the LightCycler SeptiFast Test MGRADE and conventional blood culture in the etiological diagnosis of febrile episodes occurring in neutropenic and critically ill patients (in the intensive care unit; ICU), and to assess the potential clinical value of the SeptiFast test in patient management.
A total of 86 febrile episodes occurring in 33 neutropenic patients and 53 ICU patients were analyzed. Blood samples for blood culture and SeptiFast testing were obtained at the onset of fever, before the implementation of empirical antimicrobial therapy.
The overall microorganism-to-isolate agreement between the SeptiFast test and blood culture was 69% (κ=0.37) in neutropenic patients and 75% (κ=0.56) in ICU patients. The sensitivity of the SeptiFast assay for clinically relevant episodes of bacteremia and fungemia was 62% in neutropenic patients and 70% in ICU patients. Based on SeptiFast results, empirical treatments were deemed adequate in all but one of the febrile episodes. Nevertheless, early antibiotic treatment readjustment was judged feasible in most of clinically significant episodes overall.
The SeptiFast assay is a valuable ancillary method for the diagnosis of bloodstream infections in neutropenic and ICU patients. In these clinical settings, results of the SeptiFast assay may lead to a more targeted antibiotic therapy early after the onset of fever.
本研究旨在比较 LightCycler SeptiFast Test MGRADE 与常规血培养在诊断中性粒细胞减少和危重症患者（重症监护病房；ICU）发热发作病因学中的性能，并评估 SeptiFast 试验在患者管理中的潜在临床价值。
共分析了 33 例中性粒细胞减少症患者和 53 例 ICU 患者的 86 例发热发作。在发热发作时、经验性抗菌治疗实施前，采集血样进行血培养和 SeptiFast 检测。
在中性粒细胞减少症患者中， SeptiFast 试验与血培养之间的整体微生物与分离物一致性为 69%（κ=0.37），在 ICU 患者中为 75%（κ=0.56）。 SeptiFast 检测对临床相关菌血症和真菌血症发作的敏感性在中性粒细胞减少症患者中为 62%，在 ICU 患者中为 70%。根据 SeptiFast 结果，在所有发热发作中，除一例外，经验性治疗均被认为是适当的。然而，总体而言，在大多数有临床意义的发作中，早期抗生素治疗调整被认为是可行的。
SeptiFast 检测法是诊断中性粒细胞减少和 ICU 患者血流感染的一种有价值的辅助方法。在这些临床环境中， SeptiFast 检测法的结果可能会导致在发热发作后早期更有针对性的抗生素治疗。
