Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK.
Clin Microbiol Infect. 2017 Mar;23(3):208.e1-208.e6. doi: 10.1016/j.cmi.2016.11.010. Epub 2016 Nov 23.
Blood culture results inadequately stratify the mortality risk in critically ill patients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis.
We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications.
Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001).
Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death.
血液培养结果不能充分分层脓毒症重症患者的死亡风险。我们旨在确定疑似脓毒症患者血液中存在微生物 DNA 的预后意义。
我们分析了 Rapid Diagnosis of Infections in the Critically Ill (RADICAL) 研究中收集的数据，该研究比较了一种新的非培养依赖性 PCR/电喷雾电离-质谱（ESI-MS）检测与标准微生物检测。如果患者疑似脓毒症且符合以下条件，则有资格参加该研究：住院或从六个欧洲国家的九个重症监护病房之一转来。PCR/ESI-MS 检测的血液样本与临床指征采集的初始血液培养一起采集。
在 RADICAL 研究中招募的 616 名患者中，有 439 名患者的研究结果、血液培养和 PCR/ESI-MS 检测结果可用于分析。阳性血培养和 PCR/ESI-MS 结果分别在 13%（56/439）和 40%（177/439）的患者中发现。阳性血培养（p<0.01）或阳性 PCR/ESI-MS（p<0.005）与研究入组时较高的 SOFA 评分相关。在血培养阳性或阴性的患者中，28 天死亡率无差异（35%与 32%，p=0.74）。然而，与 PCR/ESI-MS 检测结果阴性的患者相比，PCR/ESI-MS 检测结果阳性的患者死亡率显著更高（42%与 26%，p=0.001）。
疑似脓毒症患者中存在微生物 DNA 可能定义了一个死亡风险较高的患者群体。
