采用液滴数字 PCR 监测血流感染患者病原体载量和种类的前瞻性病例系列研究。

Pathogen load and species monitored by droplet digital PCR in patients with bloodstream infections: A prospective case series study.

机构信息

Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158, 310014, Hangzhou, Zhejiang, China.

出版信息

BMC Infect Dis. 2022 Oct 4;22(1):771. doi: 10.1186/s12879-022-07751-2.

DOI:10.1186/s12879-022-07751-2

PMID:36195855

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9531393/

Abstract

BACKGROUND AND OBJECTIVES

Bloodstream infection (BSI) is a life-threatening condition in critically ill patients, but pathogen quantification techniques during treatment are laborious. This study aimed to explore the impact of monitoring pathogen DNA load changes and polymicrobial infection in blood by droplet digital polymerase chain reaction (ddPCR) on the prognosis of patients with BSIs.

METHODS

This prospective case series study was conducted in the general intensive care unit of the Zhejiang Provincial People's Hospital and included patients with BSIs from May 2020 to January 2021. Pathogens DNA load and presence of polymicrobial BSIs were dynamically monitored by ddPCR.

RESULTS

Sixteen patients with BSIs proven by blood culture were recruited (87.5% men; mean age, 69.3 ± 13.7 years). All pathogens identified by blood culture were Gram-negative bacteria, among which seven were multidrug-resistant strains. The 28-day mortality rate was 62.5%. Compared to the 28-day survivors, the non-survivors were older (P = 0.04), had higher pathogen DNA load on the second (day 3-4) and third (day 6-7) ddPCR assay (P < 0.01 in both cases). In addition, the changes of pathogen DNA load in the 28-day survivors had a downward trend in the first three ddPCR assay, whereas stable load or an upward trend was observed in the 28-day non-survivors. Moreover, the number of pathogen species in patients with BSIs in the 28-day survivors decreased during the period of effective antibiotic treatment.

CONCLUSION

The changes of pathogen DNA load and species monitored in blood by ddPCR may be used to determine antibiotic efficacy and make a more accurate prognostic assessment in patients with BSIs.

摘要

背景与目的

血流感染（BSI）是重症患者危及生命的一种病症，但在治疗过程中，病原体定量技术较为繁琐。本研究旨在探索通过液滴数字聚合酶链反应（ddPCR）监测血液中病原体 DNA 载量变化和混合感染对 BSI 患者预后的影响。

方法

本前瞻性病例系列研究在浙江省人民医院综合重症监护病房进行，纳入 2020 年 5 月至 2021 年 1 月期间患有 BSI 的患者。通过 ddPCR 动态监测病原体 DNA 载量和混合 BSI 的存在。

结果

共纳入 16 例经血液培养证实的 BSI 患者（87.5%为男性；平均年龄 69.3±13.7 岁）。所有经血液培养鉴定的病原体均为革兰氏阴性菌，其中 7 株为多重耐药菌。28 天死亡率为 62.5%。与 28 天幸存者相比，非幸存者年龄更大（P=0.04），第 2 天（第 3-4 天）和第 3 天（第 6-7 天）ddPCR 检测的病原体 DNA 载量更高（均 P<0.01）。此外，28 天幸存者的病原体 DNA 载量变化在前三轮 ddPCR 检测中呈下降趋势，而 28 天非幸存者则表现为稳定的载量或上升趋势。此外，在有效抗生素治疗期间，28 天幸存者的 BSI 患者病原体种类数减少。