Pilecky Matthias, Schildberger Anita, Orth-Höller Dorothea, Weber Viktoria
Center for Biomedical Technology, Department for Biomedical Research, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria.
Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schöpfstraße 41, A-6020 Innsbruck, Austria.
Diagn Microbiol Infect Dis. 2019 May;94(1):7-14. doi: 10.1016/j.diagmicrobio.2018.11.015. Epub 2018 Nov 26.
Blood culture represents the current reference method for the detection of bacteria or fungi in the circulation. To accelerate pathogen identification, molecular diagnostic methods, mainly based on polymerase chain reaction (PCR), have been introduced to ensure early and targeted antibiotic treatment of patients suffering from bloodstream infection. Still, these approaches suffer from a lack of sensitivity and from inhibition of PCR in a number of clinical samples, leading to false negative results. To overcome these limitations, various approaches aiming at the enrichment of pathogens from larger blood volumes prior to the extraction of pathogen DNA, thereby also depleting factors interfering with PCR, have been developed. Here, we provide an overview of current systems for diagnosing bloodstream infection, with a focus on approaches for pre-analytical pathogen enrichment, and highlight emerging applications of pathogen depletion for therapeutic purposes as a potential adjunctive treatment of sepsis patients.
血培养是目前检测循环系统中细菌或真菌的参考方法。为了加快病原体鉴定，已引入主要基于聚合酶链反应（PCR）的分子诊断方法，以确保对血流感染患者进行早期且有针对性的抗生素治疗。然而，这些方法存在灵敏度不足以及在许多临床样本中抑制PCR的问题，导致假阴性结果。为克服这些局限性，已开发出各种方法，旨在从更大体积的血液中富集病原体，然后再提取病原体DNA，从而也去除干扰PCR的因素。在此，我们概述了当前用于诊断血流感染的系统，重点是分析前病原体富集方法，并强调病原体去除在治疗方面的新兴应用，作为脓毒症患者潜在的辅助治疗方法。
