Shachor-Meyouhas Yael, Sprecher Hannah, Moscoviz Danit, Zaidman Irina, Haimi Motti, Kassis Imad
*Pediatric Infectious Disease Unit †Clinical Microbiology Laboratory ‡Department of Pediatric Hematology-Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
J Pediatr Hematol Oncol. 2013 Oct;35(7):500-3. doi: 10.1097/MPH.0b013e31829eec78.
Prompt evaluation and appropriate treatment with wide-spectrum antibiotics is considered mandatory for febrile oncology patients especially during neutropenia. Central venous catheters are widely used in pediatric oncology patients and are often the source of infections. Patients are usually admitted for follow-up and administration of antibiotics. Aims were to assess the efficacy of the polymerase chain reaction (PCR) method in identifying bacteria in blood samples as compared with standard blood cultures.
This was a prospective study, which included all patients with central venous catheters admitted to the pediatric hematology-oncology department over the 14-month period. Demographic, clinical, and laboratory variables were compared in bacteremic and nonbacteremic patients. Standard microbiological cultures were compared using the PCR technique.
From September 2004 to November 2005, 148 blood cultures (70 patients) were evaluated. Positive blood cultures were detected on 21 (18.3%) occasions. PCR had sensitivity of 46%, specificity of 98%, positive predictive value 86%, and negative predictive value 89%. The PCR identified fastidious bacteria in 2 occasions when standard cultures were negative.
Inspite of low sensitivity, PCR may help with early identification of bacteremia. Improving this technology is warranted.
对于发热的肿瘤患者，尤其是在中性粒细胞减少期间，迅速进行评估并用广谱抗生素进行适当治疗被认为是必不可少的。中心静脉导管在儿科肿瘤患者中广泛使用，且常常是感染的来源。患者通常因随访和抗生素给药而入院。目的是评估聚合酶链反应（PCR）方法与标准血培养相比在鉴定血样中细菌方面的有效性。
这是一项前瞻性研究，纳入了在14个月期间入住儿科血液肿瘤科的所有中心静脉导管患者。对菌血症患者和非菌血症患者的人口统计学、临床和实验室变量进行了比较。使用PCR技术对标准微生物培养进行了比较。
2004年9月至2005年11月，共评估了148份血培养（70例患者）。在21次（18.3%）检测到血培养阳性。PCR的敏感性为46%，特异性为98%，阳性预测值为86%，阴性预测值为89%。在标准培养为阴性的2次检测中，PCR鉴定出了苛养菌。
尽管敏感性较低，但PCR可能有助于早期识别菌血症。改进这项技术是有必要的。
