Emergency Medicine, Royal Perth Hospital, University of Western Australia and Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Perth, Western Australia, Australia.
Emerg Med Australas. 2011 Aug;23(4):502-6. doi: 10.1111/j.1742-6723.2011.01445.x. Epub 2011 Jun 29.
The aim of the present study was to determine if the quantification of bacterial 16S rDNA could be clinically useful in predicting patients at increased risk of developing septic shock.
A retrospective study of patients with positive blood cultures taken on arrival to the ED. An EDTA sample was collected simultaneously with blood cultures and assayed by polymerase chain reaction to quantitate the bacterial 16S rDNA load. Descriptive and clinical data were collected from the medical record and this was blinded to the 16S rDNA result. Subsequently, the 16S rDNA result was compared with illness severity markers including septic shock and death to determine the relationship between the 16S rDNA load and illness severity.
98 patients (mean age 61 ± 20 years, range 18-92) with positive blood cultures were studied, most commonly growing Escherichia coli (n= 25) and Staphylococcus aureus (n= 23). 16 (16%) died. There were 42 (43%) 16S rDNA positive patients. A high 16S rDNA load was associated with an increased risk of developing delayed septic shock (OR 21.9, 95% CI 2.5-192.6) in comparison with either a low or negative 16S rDNA load; with a mortality OR 4.6 (95% CI 0.9-23.5).
The quantitative assay for 16S rDNA might be a useful screening tool to detect severe sepsis in those whom it might not be clinically suspected. However, prospective studies are required to further assess the clinical usefulness of this assay.
本研究旨在确定细菌 16S rDNA 的定量检测是否可用于临床预测发生感染性休克的高危患者。
本研究为回顾性研究，纳入急诊（ED）就诊时血培养阳性的患者。同时采集 EDTA 样本进行血培养，并通过聚合酶链反应（PCR）定量检测细菌 16S rDNA 负荷。从病历中收集描述性和临床数据，并对这些数据进行盲法处理，不了解 16S rDNA 结果。随后，将 16S rDNA 结果与疾病严重程度标志物（包括感染性休克和死亡）进行比较，以确定 16S rDNA 负荷与疾病严重程度之间的关系。
本研究共纳入 98 例血培养阳性患者（平均年龄 61 ± 20 岁，范围 18-92 岁），最常见的病原体为大肠埃希菌（n=25）和金黄色葡萄球菌（n=23）。16 例（16%）患者死亡。42 例（43%）患者 16S rDNA 阳性。与低或阴性 16S rDNA 负荷相比，高 16S rDNA 负荷与发生迟发性感染性休克的风险增加相关（比值比 21.9，95%可信区间 2.5-192.6）；与死亡率的比值比为 4.6（95%可信区间 0.9-23.5）。
16S rDNA 的定量检测可能是一种有用的筛查工具，用于检测那些临床上可能未被怀疑为严重感染的患者。然而，需要前瞻性研究进一步评估该检测的临床实用性。
