Mitsuda Yoshihiro, Takeshima Yasuhiro, Mori Takeshi, Yanai Tomoko, Hayakawa Akira, Matsuo Masafumi
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Kobe J Med Sci. 2011 Aug 17;57(2):E32-7.
Febrile neutropenia (FN) is a life-threatening complication, and the primary cause of FN is considered to be microbial infection. Therefore, prompt and appropriate antimicrobial therapy is crucial. Clinicians usually prescribe antimicrobial therapy on the basis of presumptive and empirical data. This is because the causative pathogen for FN in blood culture (BC) analysis is detected several days after sampling. Polymerase chain reaction (PCR) analysis has been used for detecting the causative bacteria of infections. Here, we examined whether multiplex PCR is useful for detecting the causative pathogens for FN patients. We extracted DNA from the patients' whole blood and performed multiplex PCR. In total, 128 samples of 40 patients clinically diagnosed with FN were used in this study. Multiplex PCR analysis revealed the causative pathogen in 3 patients with FN; the DNA fragments amplified were those of Pseudomonas aeruginosa in 2 cases and Psedomonas putida in 1 case. These patients could be started on appropriate antimicrobial therapy a few hours after sampling. However, the DNA fragment of the causative pathogen could not be amplified by PCR in 2 patients, although BC analysis did detect the causative bacteria. Thus, we conclude that multiplex PCR is serviceable in case of FN because of its rapidness. However, BC is also indispensable to treating FN owing to its high sensitivity.
发热性中性粒细胞减少症（FN）是一种危及生命的并发症，FN的主要原因被认为是微生物感染。因此，及时且恰当的抗菌治疗至关重要。临床医生通常根据推测性和经验性数据来开具抗菌治疗处方。这是因为在血培养（BC）分析中，FN的致病病原体在采样几天后才能被检测到。聚合酶链反应（PCR）分析已被用于检测感染的致病细菌。在此，我们研究了多重PCR是否有助于检测FN患者的致病病原体。我们从患者全血中提取DNA并进行多重PCR。本研究共使用了40例临床诊断为FN患者的128份样本。多重PCR分析在3例FN患者中检测到了致病病原体；扩增出的DNA片段在2例中为铜绿假单胞菌，1例中为恶臭假单胞菌。这些患者在采样后数小时即可开始接受恰当的抗菌治疗。然而，尽管BC分析检测到了致病细菌，但在2例患者中PCR未能扩增出致病病原体的DNA片段。因此，我们得出结论，多重PCR因其快速性在FN病例中是有用的。然而，由于BC的高敏感性，它在治疗FN时也是不可或缺的。
