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Clinical Relevance of Pathogens Detected by Multiplex PCR in Blood of Very-Low-Birth Weight Infants with Suspected Sepsis - Multicentre Study of the German Neonatal Network
- Source :
- PLoS ONE, PLoS ONE, Vol 11, Iss 7, p e0159821 (2016)
- Publication Year :
- 2016
-
Abstract
- Introduction In the German Neonatal Network (GNN) 10% of very-low-birth weight infants (VLBWI) suffer from blood-culture confirmed sepsis, while 30% of VLBWI develop clinical sepsis. Diagnosis of sepsis is a difficult task leading to potential over-treatment with antibiotics. This study aims to investigate whether the results of blood multiplex-PCR (SeptiFast®) for common sepsis pathogens are relevant for clinical decision making when sepsis is suspected in VLBWI. Methods We performed a prospective, multi-centre study within the GNN including 133 VLBWI with 214 episodes of suspected late onset sepsis (LOS). In patients with suspected sepsis a multiplex-PCR (LightCycler SeptiFast MGRADE-test®) was performed from 100 μl EDTA blood in addition to center-specific laboratory biomarkers. The attending neonatologist documented whether the PCR-result, which was available after 24 to 48 hrs, had an impact on the choice of antibiotic drugs and duration of therapy. Results PCR was positive in 110/214 episodes (51%) and blood culture (BC) was positive in 55 episodes (26%). Both methods yielded predominantly coagulase-negative staphylococci (CoNS) followed by Escherichia coli and Staphylococcus aureus. In 214 BC—PCR paired samples concordant results were documented in 126 episodes (59%; n = 32 were concordant pathogen positive results, n = 94 were negative in both methods). In 65 episodes (30%) we found positive PCR results but negative BCs, with CoNS being identified in 43 (66%) of these samples. Multiplex-PCR results influenced clinical decision making in 30% of episodes, specifically in 18% for the choice of antimicrobial therapy and in 22% for the duration of antimicrobial therapy. Conclusions Multiplex-PCR results had a moderate impact on clinical management in about one third of LOS-episodes. The main advantage of multiplex-PCR was the rapid detection of pathogens from micro-volume blood samples. In VLBWI limitations include risk of contamination, lack of resistance testing and high costs. The high rate of positive PCR results in episodes of negative BC might lead to overtreatment of infants which is associated with risk of mortality, antibiotic resistance, fungal sepsis and NEC.
- Subjects :
- 0301 basic medicine
Male
Physiology
Medizin
lcsh:Medicine
Drug resistance
Pathology and Laboratory Medicine
Infant, Newborn, Diseases
0302 clinical medicine
Antibiotics
Germany
Medicine and Health Sciences
Infant, Very Low Birth Weight
Blood culture
030212 general & internal medicine
Prospective Studies
lcsh:Science
Fungal Pathogens
Antiinfective agent
Multidisciplinary
Neonatal sepsis
medicine.diagnostic_test
Antimicrobials
Drugs
Hematology
Bacterial Pathogens
Body Fluids
Blood
Medical Microbiology
Female
Pathogens
Anatomy
Neonatal Sepsis
Research Article
medicine.medical_specialty
030106 microbiology
Mycology
Microbiology
Specimen Handling
Sepsis
03 medical and health sciences
Pharmacotherapy
Signs and Symptoms
Diagnostic Medicine
Internal medicine
Microbial Control
medicine
Humans
Clinical significance
Neonatology
Intensive care medicine
Microbial Pathogens
Pharmacology
business.industry
lcsh:R
Infant, Newborn
Biology and Life Sciences
medicine.disease
Antibiotic Resistance
lcsh:Q
Antimicrobial Resistance
business
Multiplex Polymerase Chain Reaction
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- PLoS ONE, PLoS ONE, Vol 11, Iss 7, p e0159821 (2016)
- Accession number :
- edsair.doi.dedup.....4ceef403b7eddd9b5ad688aac9a810f6