Department of Internal Medicine, University Hospital, Basel, Switzerland;
Swiss Med Wkly. 2014 Feb 4;144:w13911. doi: 10.4414/smw.2014.13911.
Delayed recognition of sepsis and inappropriate initial antibiotic therapy are associated with increased mortality and morbidity. The early detection of the causative organism in sepsis is an unmet clinical need. A novel multiplex real-time polymerase chain reaction (MRT-PCR) (SeptiFast®) technique may provide the microbiological diagnosis within six hours.
We assessed the diagnostic accuracy of blood cultures and MRT-PCR in a comparative diagnostic cohort study in 110 consecutive adult patients presenting to the emergency department (ED) with suspected sepsis.
We collected 205 corresponding PCR samples and blood culture (BC) pairs from the 110 patients. There was moderate to high concordance between PCR and BC with 181 (88%) matching and 24 (12%) mismatching samples. The diagnostic accuracy of MRT-PCR in detecting sepsis and its causative organism was comparable to that of BCs. The additional use of MRT-PCR significantly reduced the time to microbiological diagnosis as compared to the use of conventional microbiological methods alone (mean time gained 3.9 hours, range 0-66 hours, p <0.001).
Diagnostic accuracy of BCs and MRT-PCR in the early diagnosis of sepsis and its causative organism in the ED are comparable. However, MRT-PCR reduces the time to microbiological diagnosis. Whether a more rapid detection of the organism by MRT-PCR could improve the outcome of patients has to be assessed in large prospective randomised trials.
脓毒症的延迟识别和初始抗生素治疗不当与死亡率和发病率增加有关。脓毒症中病原体的早期检测是一个未满足的临床需求。一种新的多重实时聚合酶链反应（MRT-PCR）（SeptiFast®）技术可能在六小时内提供微生物学诊断。
我们在一项连续 110 例成人疑似脓毒症患者的比较诊断队列研究中评估了血培养和 MRT-PCR 的诊断准确性。
我们从 110 例患者中收集了 205 对相应的 PCR 样本和血培养（BC）。PCR 和 BC 之间具有中度至高度一致性，181 个（88%）匹配，24 个（12%）不匹配。MRT-PCR 检测脓毒症及其病原体的诊断准确性与 BC 相当。与单独使用传统微生物学方法相比，额外使用 MRT-PCR 可显著缩短微生物学诊断时间（平均时间增加 3.9 小时，范围 0-66 小时，p<0.001）。
ED 中 BC 和 MRT-PCR 对脓毒症及其病原体的早期诊断具有相当的诊断准确性。然而，MRT-PCR 缩短了微生物学诊断的时间。MRT-PCR 更快地检测病原体是否能改善患者的预后，需要在大型前瞻性随机试验中进行评估。
