Multiplex Blood PCR in Combination with Blood Cultures for Improvement of Microbiological Documentation of Infection in Febrile Neutropenia

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ID: 113380
2010
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Abstract
The frequent lack of microbiological documentation of infection by blood cultures (BC) has a major impact on clinical management of febrile neutropenic patients, especially in cases of unexplained persistent fever. We assessed the diagnostic utility of the LightCycler SeptiFast test (SF), a multiplex blood PCR, in febrile neutropenia. Blood for BC and SF was drawn at the onset of fever and every 3 days of persistent fever. SF results were compared with those of BC, clinical documentation of infection, and standard clinical, radiological, and microbiological criteria for invasive fungal infections (IFI). A total of 141 febrile neutropenic episodes in 86 hematological patients were studied: 44 (31%) microbiologically and 49 (35%) clinically documented infections and 48 (34%) unexplained fevers. At the onset of fever, BC detected 44 microorganisms in 35/141 (25%) episodes. Together, BC and SF identified 78 microorganisms in 61/141 (43%) episodes ( P = 0.002 versus BC or SF alone): 12 were detected by BC and SF, 32 by BC only, and 34 by SF only. In 19/52 (37%) episodes of persistent fever, SF detected 28 new microorganisms (7 Gram-positive bacterial species, 15 Gram-negative bacterial species, and 6 fungal species [89% with a clinically documented site of infection]) whereas BC detected only 4 pathogens (8%) ( P = 0.001). While BC did not detect fungi, SF identified 5 Candida spp. and 1 Aspergillus sp. in 5/7 probable or possible cases of IFI. Using SeptiFast PCR combined with blood cultures improves microbiological documentation in febrile neutropenia, especially when fever persists and invasive fungal infection is suspected. Technical adjustments may enhance the efficiency of this new molecular tool in this specific setting.
Reference Key
lamoth2010journalmultiplex Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors F. Lamoth;K. Jaton;G. Prod'hom;L. Senn;J. Bille;T. Calandra;O. Marchetti;F. Lamoth;K. Jaton;G. Prod'hom;L. Senn;J. Bille;T. Calandra;O. Marchetti;
Journal Journal of clinical microbiology
Year 2010
DOI
10.1128/JCM.00147-10
URL
http://dx.doi.org/10.1128/JCM.00147-10
Keywords
National Center for Biotechnology Information NCBI NLM MEDLINE humans pubmed abstract nih national institutes of health national library of medicine research support non-u.s. gov't adult female male adolescent aged middle aged young adult Bacteria / genetics Bacteria / isolation & purification* Polymerase Chain Reaction / methods* fungi / genetics immunocompromised host bacterial infections / diagnosis* neutropenia / complications fungi / isolation & purification* bacteria / growth & development fever of unknown origin / complications* pmid:20720024 pmc2953112 doi:10.1128/jcm.00147-10 f lamoth k jaton o marchetti blood / microbiology* fungi / growth & development microbiological techniques / methods mycoses / diagnosis*

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