Multiplex polymerase chain reaction detection enhancement of bacteremia and fungemia

Richard F. Louie, Zuping Tang, Timothy E Albertson, Stuart H Cohen, Nam Tran, Gerald J Kost

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

OBJECTIVE: To test a multiplex real-time polymerase chain reaction (PCR) method for simultaneous detection of multiple organisms in bloodstream infections. METHODS: Prospective observational study at the University of California Davis Medical Center (Sacramento, CA). Two hundred adult (>18 yrs) patients from the emergency room, intensive care units, and general medicine wards at risk of a bloodstream infection and who manifested signs of systemic inflammatory response syndrome (SIRS). Whole blood samples for PCR testing were collected at the same time as blood culture (BC). PCR results were compared to blood and other culture results. RESULTS: PCR detected potentially significant bacteria and fungi in 45 cases compared to 37 by BC. PCR detected the methicillin resistance (mecA) gene in all three culture-confirmed methicillin-resistant Staphylococcus aureus cases. More than 68% of PCR results were confirmed by blood, urine, and catheter culture. Independent clinical arbitrators could not rule out the potential clinical significance of organism(s) detected by PCR, but not by BC. PCR did not detect Enterococcus faecalis in five BC-confirmed cases. On average, seven patient samples could be tested simultaneously with the PCR method in 6.54 ± .27 hrs. CONCLUSIONS: Multiplex PCR detected potentially significant bacteria and fungi that were not found by BC. BC found organisms that were not detected by PCR. Despite limitations of both BC and PCR methods, PCR could serve as an adjunct to current culture methods to facilitate early detection of bloodstream infections. Early detection of microorganisms has the potential to facilitate evidence-based treatment decisions, antimicrobial selection, and adequacy of antimicrobial therapy.

Original languageEnglish (US)
Pages (from-to)1487-1492
Number of pages6
JournalCritical Care Medicine
Volume36
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Fungemia
Multiplex Polymerase Chain Reaction
Bacteremia
Polymerase Chain Reaction
Patients' Rooms
Fungi
Infection
Bacteria
Systemic Inflammatory Response Syndrome
Methicillin Resistance
Enterococcus faecalis
Methicillin-Resistant Staphylococcus aureus
Blood Culture
Observational Studies
Intensive Care Units
Hospital Emergency Service
Real-Time Polymerase Chain Reaction
Catheters

Keywords

  • Coagulase-negative Staphylococcus (CoNS) contamination
  • Methicillin- resistant Staphylococcus aureus (MRSA)
  • Polymicrobial
  • Real-time polymerase chain reaction
  • Sepsis
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Multiplex polymerase chain reaction detection enhancement of bacteremia and fungemia. / Louie, Richard F.; Tang, Zuping; Albertson, Timothy E; Cohen, Stuart H; Tran, Nam; Kost, Gerald J.

In: Critical Care Medicine, Vol. 36, No. 5, 05.2008, p. 1487-1492.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To test a multiplex real-time polymerase chain reaction (PCR) method for simultaneous detection of multiple organisms in bloodstream infections. METHODS: Prospective observational study at the University of California Davis Medical Center (Sacramento, CA). Two hundred adult (>18 yrs) patients from the emergency room, intensive care units, and general medicine wards at risk of a bloodstream infection and who manifested signs of systemic inflammatory response syndrome (SIRS). Whole blood samples for PCR testing were collected at the same time as blood culture (BC). PCR results were compared to blood and other culture results. RESULTS: PCR detected potentially significant bacteria and fungi in 45 cases compared to 37 by BC. PCR detected the methicillin resistance (mecA) gene in all three culture-confirmed methicillin-resistant Staphylococcus aureus cases. More than 68{\%} of PCR results were confirmed by blood, urine, and catheter culture. Independent clinical arbitrators could not rule out the potential clinical significance of organism(s) detected by PCR, but not by BC. PCR did not detect Enterococcus faecalis in five BC-confirmed cases. On average, seven patient samples could be tested simultaneously with the PCR method in 6.54 ± .27 hrs. CONCLUSIONS: Multiplex PCR detected potentially significant bacteria and fungi that were not found by BC. BC found organisms that were not detected by PCR. Despite limitations of both BC and PCR methods, PCR could serve as an adjunct to current culture methods to facilitate early detection of bloodstream infections. Early detection of microorganisms has the potential to facilitate evidence-based treatment decisions, antimicrobial selection, and adequacy of antimicrobial therapy.",
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