SeptiFast versus blood culture in clinical routine – A report on 3 years experience

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Summary

Background

In recent years a multiplex real-time PCR (SeptiFast) has been introduced, allowing detection of 25 common blood pathogens considerably faster than conventional blood culture.

Methods

SeptiFast was applied routinely in addition to blood culture in cases of critically ill patients with fever and other signs of severe systemic infections. In this study data of 470 episodes were retrospectively analysed to assess the impact of various parameters, such as clinical indications, assigning ward and antimicrobial treatment on test outcome using a multivariate logistic model.

Results

After exclusion of microorganisms classified as contaminants, the concordance between SeptiFast and blood culture was 85.5%. SeptiFast detected 98 out of 120, while blood culture merely found 63 out of 120 potential pathogens. In comparison to blood culture, SeptiFast showed considerably higher positivity rates in sepsis, pneumonia and febrile immunosuppression and a lower rate in endocarditis. The highest positivity and concordance between tests was shown in patients from the emergency room ( P = 0.007).

Conclusions

The results obtained in this study are similar to those from prospective settings confirming the robustness of the SeptiFast assay in routine use. Our data suggest that SeptiFast is a valuable add-on to blood culture and may increase the diagnostic efficiency of a microbiological laboratory.

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Most cited references 37

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Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis.

Rogelio F Jiménez-Ortega, Ana Almodóvar, J Garmendia … (2003)

Our primary goal was to evaluate the impact on in-hospital mortality rate of adequate empirical antibiotic therapy, after controlling for confounding variables, in a cohort of patients admitted to the intensive care unit (ICU) with sepsis. The impact of adequate empirical antibiotic therapy on early (<3 days), 28-day, and 60-day mortality rates also was assessed. We determined the risk factors for inadequate empirical antibiotic therapy. DESIGN Prospective cohort study. ICU of a tertiary hospital. All the patients meeting criteria for sepsis at admission to the ICU. None. Four hundred and six patients were included. Microbiological documentation of sepsis was obtained in 67% of the patients. At ICU admission, sepsis was present in 105 patients (25.9%), severe sepsis in 116 (28.6%), and septic shock in 185 (45.6%). By multivariate analysis, predictors of in-hospital mortality were Sepsis-related Organ Failure Assessment (SOFA) score at ICU admission (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.19-1.40), the increase in SOFA score over the first 3 days in the ICU (OR, 1.40; 95% CI, 1.19-1.65), respiratory failure within the first 24 hrs in the ICU (OR, 3.12; 95% CI, 1.54-6.33), and inadequate empirical antimicrobial therapy in patients with "nonsurgical sepsis" (OR, 8.14; 95% CI, 1.98-33.5), whereas adequate empirical antimicrobial therapy in "surgical sepsis" (OR, 0.37; 95% CI, 0.18-0.77) and urologic sepsis (OR, 0.14; 95% CI, 0.05-0.41) was a protective factor. Regarding early mortality (<3 days), factors associated with fatality were immunosuppression (OR, 4.57; 95% CI, 1.69-13.87), chronic cardiac failure (OR, 9.83; 95% CI, 1.98-48.69) renal failure within the first 24 hrs in the unit (OR, 8.63; 95% CI, 3.31-22.46), and respiratory failure within the first 24 hrs in the ICU (OR, 12.35; 95% CI, 4.50-33.85). Fungal infection (OR, 47.32; 95% CI, 5.56-200.97) and previous antibiotic therapy within the last month (OR, 2.23; 95% CI, 1.1-5.45) were independent variables related to administration of inadequate antibiotic therapy. In patients admitted to the ICU for sepsis, the adequacy of initial empirical antimicrobial treatment is crucial in terms of outcome, although early mortality rate was unaffected by the appropriateness of empirical antibiotic therapy.

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New developments in the diagnosis of bloodstream infections.

S. Danner, Odile van den Heuvel, Christina M. J. E. Vandenbroucke-Grauls … (2004)

New techniques have emerged for the detection of bacteria in blood, because the blood culture as gold standard is slow and insufficiently sensitive when the patient has previously received antibiotics or in the presence of fastidious organisms. DNA-based techniques, hybridisation probes, and PCR-based detection or protein-based detection by mass spectroscopy are aimed at rapid identification of bacteria and provide results within 2 h after the first signal of growth in conventional blood cultures. Also, detection of microorganisms directly in blood by pathogen-specific or broad-range PCR assays (eubacterial or panfungal) shows promising results. Interpretation is complex, however, because of detection of DNA rather than living pathogens, the risk of interfering contamination, the presence of background DNA in blood, and the lack of a gold standard. As these techniques are emerging, clinical value and cost-effectiveness have to be assessed. Nevertheless, molecular assays are expected eventually to replace the current conventional microbiological techniques for detection of bloodstream infections.

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A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples.

Lutz Eric Lehmann, Klaus-Peter Hunfeld, Thomas Emrich … (2008)

Early detection of bloodstream infections (BSI) is crucial in the clinical setting. Blood culture remains the gold standard for diagnosing BSI. Molecular diagnostic tools can contribute to a more rapid diagnosis in septic patients. Here, a multiplex real-time PCR-based assay for rapid detection of 25 clinically important pathogens directly from whole blood in <6 h is presented. Minimal analytical sensitivity was determined by hit rate analysis from 20 independent experiments. At a concentration of 3 CFU/ml a hit rate of 50% was obtained for E. aerogenes and 100% for S. marcescens, E. coli, P. mirabilis, P. aeruginosa, and A. fumigatus. The hit rate for C. glabrata was 75% at 30 CFU/ml. Comparing PCR identification results with conventional microbiology for 1,548 clinical isolates yielded an overall specificity of 98.8%. The analytical specificity in 102 healthy blood donors was 100%. Although further evaluation is warranted, our assay holds promise for more rapid pathogen identification in clinical sepsis.

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Author and article information

Contributors

Athanasios Makristathis: +43-1-4040051570 , +43-1-4040051620 , athanasios.makristathis@meduniwien.ac.at

Journal

Journal ID (nlm-ta): Wien Klin Wochenschr

Journal ID (iso-abbrev): Wien. Klin. Wochenschr

Title: Wiener Klinische Wochenschrift

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0043-5325

ISSN (Electronic): 1613-7671

Publication date (Electronic): 27 February 2017

Publication date PMC-release: 27 February 2017

Publication date (Print): 2017

Volume: 129

Issue: 11

Pages: 427-434

Affiliations

[1 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Division of Clinical Microbiology, Department of Laboratory Medicine, , Medical University Vienna, ; Währinger Gürtel 18-20, 1090 Vienna, Austria

[2 ]Praxis Dr. med. Norbert Haßfurther, Launsbach, Germany

[3 ]GRID grid.414473.1, , Krankenhaus der Elisabethinen Linz, ; Linz, Austria

Article

Publisher ID: 1181

DOI: 10.1007/s00508-017-1181-3

PMC ID: 5486735

PubMed ID: 28243751

SO-VID: a925b68b-d945-4fa8-bcfe-be981e5e110d

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 16 November 2016

Date accepted : 8 February 2017

Funding

Funded by: Medical University of Vienna

Open Access :

Open access funding provided by Medical University of Vienna.

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: septifast,blood culture,sepsis,routine use,diagnostics

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ScienceOpen disciplines: Medicine

Keywords: septifast, blood culture, sepsis, routine use, diagnostics

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SeptiFast versus blood culture in clinical routine – A report on 3 years experience

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Summary

Background

Methods

Results

Conclusions

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CHAIN Network Collection

Most cited references 37

Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis.

New developments in the diagnosis of bloodstream infections.

A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples.

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Cited by 15

Most referenced authors 1,230