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通过聚合酶链反应(PCR)检测腹腔液中的DNA以优化高危重症监护病房(ICU)患者腹腔念珠菌病的诊断和治疗:一项前瞻性队列研究。

Detection of DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study.

作者信息

Xie Min, Shao Jin, Wan Zhe, Yan Ting, Zhu Sainan, Li Shuangling, Yu Jin

机构信息

Department of Critical Care Medicine, Peking University First Hospital, Peking University, Beijing, China.

Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.

出版信息

Front Microbiol. 2023 Jan 5;13:1070688. doi: 10.3389/fmicb.2022.1070688. eCollection 2022.

Abstract

BACKGROUND

Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill patients. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting DNA in peritoneal fluids (PF) is useful in diagnosing and management of IAC in high-risk patients in intensive care unit (ICU).

METHODS

A prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1-3)-β-D-glucan were performed in all patients. For PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8 s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria.

RESULTS

Among 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the PCR assay were 64.7 and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63-0.91). In this cohort, the positive predictive value and negative predictive value were 90.8% (95% CI: 80.3-96.2%) and 61.1% (95% CI: 36.1-81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529,  < 0.001) according to the 2013 European consensus criteria.

CONCLUSION

Detection of DNA in PF using PCR can be considered an adjunct to existing routine diagnostic tools which may optimize the diagnosis and antifungal treatment of IAC in high-risk patients in the ICU.

摘要

背景

腹腔念珠菌病(IAC)是危重症患者侵袭性念珠菌病的主要类型,死亡率高。本研究旨在探讨检测腹腔液(PF)中DNA的聚合酶链反应(PCR)检测法对重症监护病房(ICU)高危患者IAC的诊断和管理是否有用。

方法

在ICU对IAC高危手术患者进行前瞻性单中心队列研究。通过腹腔引流管(24小时内)或经皮穿刺收集PF。对所有患者进行PF直接涂片显微镜检查、PF培养、血培养和血清(1-3)-β-D-葡聚糖检测。对于PCR检测,使用靶向ITS1-5.8 s-ITS2区域的ITS1/ITS4引物进行PCR,并进行测序分析以在种水平鉴定病原体。IAC根据2013年欧洲共识标准定义。

结果

在83例IAC高危患者中,17例(20.5%)符合IAC标准。PCR检测法的敏感性和特异性分别为64.7%和89.4%,受试者工作特征曲线下面积为0.77(95%CI:0.63-0.91)。在该队列中,阳性预测值和阴性预测值分别为90.8%(95%CI:80.3-96.2%)和61.1%(95%CI:36.1-81.7%)。根据2013年欧洲共识标准,诊断一致性为中等(kappa 0.529,P < 0.001)。

结论

使用PCR检测PF中的DNA可被视为现有常规诊断工具的辅助手段,这可能优化ICU高危患者IAC的诊断和抗真菌治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94d6/9849671/49bb8f77c90a/fmicb-13-1070688-g001.jpg

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