Zheng Bei, Xin Chuanwei, Liu Yizhuo, Lv Enhui, Jiang Hong, Yang Wenjuan, Jiang Yuxia, Yang Bo, Jiang Huifang, Zhang Meiling, Tu Yuexing
Department of Pharmacy, Tongde Hospital of Zhejiang Province Affiliated to Zhejiang Chinese Medical University (Tongde Hospital of Zhejiang Province), Hangzhou, 310012, Zhejiang, China.
Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, 310012, Zhejiang, China.
Infect Dis Ther. 2025 Aug 29. doi: 10.1007/s40121-025-01207-1.
Early antibacterial treatment is critical for patients with hematologic malignancies (HMs) and sepsis. Droplet digital polymerase chain reaction (ddPCR) can rapidly detect pathogens and antimicrobial resistance (AMR) genes, but its clinical value in HMs is unknown. This study aimed to systematically evaluate the role of ddPCR in diagnosis, clinical outcomes, and antimicrobial stewardship.
From January 2023 to March 2025, 400 patients with hematologic malignancies (HMs) and sepsis were enrolled in the study. Of these, 150 received both ddPCR and blood culture (BC), while 250 underwent BC alone. Using propensity score matching (PSM), as well as subgroup and sensitivity analyses, we evaluated ten indicators, including 28-day mortality, treatment efficacy, and antibiotic use density (AUD).
ddPCR showed a 49.33% positive rate (vs. BC's 17.50%, P < 0.01) with a 4.06-h diagnostic turnaround (vs. 72.47 h for BC, P < 0.01), achieving 70.37% sensitivity and 55.28% specificity. The ddPCR group had lower 28-day mortality (HR = 0.55, P = 0.01), higher clinical response rates, and greater inflammatory marker decline. Antimicrobial optimization via ddPCR improved efficacy to 85.11%, with reduced AUD (OR = - 28.93, P < 0.01), the quantity and proportion of combined antimicrobial usage. However, a non-significant difference was observed in the proportion of antibacterial treatment costs (P = 0.14). PSM and sensitivity analysis results were consistent, indicating data robustness.
ddPCR outperforms BC in diagnostic efficiency for patients with HMs and sepsis, accelerating pathogen and AMR genes identification, optimizing antibacterial therapy and management, improving clinical effectiveness, and reducing 28-day all-cause mortality. The findings support the application of ddPCR in immunosuppressed populations.
早期抗菌治疗对血液系统恶性肿瘤（HM）合并脓毒症患者至关重要。液滴数字聚合酶链反应（ddPCR）可快速检测病原体及抗菌药物耐药（AMR）基因，但其在HM中的临床价值尚不清楚。本研究旨在系统评估ddPCR在诊断、临床结局及抗菌药物管理中的作用。
2023年1月至2025年3月，400例血液系统恶性肿瘤合并脓毒症患者纳入本研究。其中150例接受了ddPCR和血培养（BC），250例仅接受血培养。采用倾向评分匹配（PSM）以及亚组和敏感性分析，我们评估了包括28天死亡率、治疗效果和抗生素使用密度（AUD）在内的10项指标。
ddPCR阳性率为49.33%（BC为17.50%，P<0.01），诊断周转时间为4.06小时（BC为72.47小时，P<0.01），敏感性达70.37%，特异性为55.28%。ddPCR组28天死亡率较低（HR=0.55，P=0.01），临床缓解率较高，炎症标志物下降更明显。通过ddPCR进行抗菌药物优化使疗效提高到85.11%，AUD降低（OR=-28.93，P<0.01），联合使用抗菌药物的数量和比例减少。然而，抗菌治疗费用比例差异无统计学意义（P=0.14）。PSM和敏感性分析结果一致，表明数据稳健。
对于血液系统恶性肿瘤合并脓毒症患者，ddPCR在诊断效率上优于血培养，可加速病原体及AMR基因鉴定，优化抗菌治疗与管理，提高临床疗效，降低28天全因死亡率。研究结果支持ddPCR在免疫抑制人群中的应用。
