Medical-Surgical Intensive Care Unit, CHU Dupuytren, Limoges, France.
J Crit Care. 2012 Aug;27(4):416.e1-6. doi: 10.1016/j.jcrc.2011.11.005. Epub 2012 Jan 9.
The purpose of this study is to evaluate the feasibility and interest of real-time polymerase chain reaction (RT-PCR) testing for bacterial genomes in body fluids other than blood in patients with acute severe sepsis.
Twenty-six consecutive patients admitted for severe sepsis or septic shock were prospectively studied. Body fluids were sampled as clinically indicated and tested using standard microbiological methods and modified RT-PCR methods (universal PCR and specific PCRs). Results of standard microbiological tests were compared with those of PCR tests.
Direct RT-PCR testing was successfully performed on all nonblood body fluids. Of 29 body fluids collected, 23 were positive for at least 1 microorganism with conventional tests. Of 18 microbiological tests positive for a single microorganism, 15 fully agreed with RT-PCR assays, and the remaining 3 samples were infected with bacteria not screened by PCR testing. Among the 5 polymicrobial results obtained with conventional tests, RT-PCR agreed in 4 patients. The RT-PCR tests allowed additional clinically relevant bacterial identification in 3 of 6 samples with negative microbiological culture.
Our results indicate that direct PCR testing may improve the detection of bacteria in body fluids other than blood in patients with acute severe sepsis.
本研究旨在评估实时聚合酶链反应（RT-PCR）检测血液以外体液中细菌基因组在急性重症脓毒症患者中的可行性和应用价值。
连续前瞻性研究 26 例因严重脓毒症或感染性休克而入院的患者。根据临床指征采集体液样本，采用标准微生物学方法和改良 RT-PCR 方法（通用 PCR 和特异性 PCR）进行检测。将标准微生物学检测结果与 PCR 检测结果进行比较。
直接 RT-PCR 检测可成功应用于所有非血体液。29 份采集的体液中，23 份至少有一种微生物常规检测阳性。18 份单一微生物的微生物学检测阳性中，15 份与 RT-PCR 检测完全一致，其余 3 份样本感染了 PCR 检测未筛查到的细菌。在 5 份常规检测获得的混合微生物检测结果中，RT-PCR 在 4 例患者中一致。在 6 份微生物培养阴性的样本中，RT-PCR 检测额外鉴定出 3 种具有临床相关性的细菌。
我们的研究结果表明，直接 PCR 检测可能提高急性重症脓毒症患者血液以外体液中细菌的检出率。
