M J O'Dwyer1, M H Starczewska2, J Schrenzel3, K Zacharowski4, D J Ecker5, R Sampath5, D Brealey6, M Singer6, N Libert7, M Wilks8, J-L Vincent9. 1. Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Electronic address: m.odwyer@qmul.ac.uk. 2. Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, UK. 3. Genomic Research Laboratory, Department of Internal Medicine, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland. 4. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany. 5. Ibis Biosciences, Abbott, Carlsbad, CA, USA. 6. Division of Critical Care, University College London Hospitals NIHR Biomedical Research Centre and Bloomsbury Institute of Intensive Care Medicine, University College Hospital, London, United Kingdom. 7. Department of Anaesthesiology and Critical Care, Val de Grâce Military Hospital, Paris, France. 8. Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK. 9. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Abstract
OBJECTIVES: Blood culture results inadequately stratify the mortality risk in critically ill patients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis. METHODS: We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications. RESULTS: Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001). CONCLUSIONS: Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death.
OBJECTIVES: Blood culture results inadequately stratify the mortality risk in critically illpatients with sepsis. We sought to establish the prognostic significance of the presence of microbial DNA in the bloodstream of patients hospitalized with suspected sepsis. METHODS: We analysed the data collected during the Rapid Diagnosis of Infections in the Critically Ill (RADICAL) study, which compared a novel culture-independent PCR/electrospray ionization-mass spectrometry (ESI-MS) assay with standard microbiological testing. Patients were eligible for the study if they had suspected sepsis and were either hospitalized or were referred to one of nine intensive care units from six European countries. The blood specimen for PCR/ESI-MS assay was taken along with initial blood culture taken for clinical indications. RESULTS: Of the 616 patients recruited to the RADICAL study, 439 patients had data on outcome, results of the blood culture and PCR/ESI-MS assay available for analysis. Positive blood culture and PCR/ESI-MSI result was found in 13% (56/439) and 40% (177/439) of patients, respectively. Either a positive blood culture (p 0.01) or a positive PCR/ESI-MS (p 0.005) was associated with higher SOFA scores on enrolment to the study. There was no difference in 28-day mortality observed in patients who had either positive or negative blood cultures (35% versus 32%, p 0.74). However, in patients with a positive PCR/ESI-MS assay, mortality was significantly higher in comparison to those with a negative result (42% versus 26%, p 0.001). CONCLUSIONS: Presence of microbial DNA in patients with suspected sepsis might define a patient group at higher risk of death.
Authors: Janette M Harro; Mark E Shirtliff; William Arnold; Jennifer M Kofonow; Chad Dammling; Yvonne Achermann; Kristen Brao; Javad Parvizi; Jeff G Leid Journal: J Clin Microbiol Date: 2020-04-23 Impact factor: 5.948
Authors: Kristoffer Strålin; Richard E Rothman; Volkan Özenci; Kieron Barkataki; David Brealey; Neelam Dhiman; Lara Poling; Michael C Kurz; Ajit P Limaye; Frank LoVecchio; Kristin Lowery; Loren G Miller; Gregory J Moran; J Scott Overcash; Amisha Parekh; W Frank Peacock; Emanuel P Rivers; Matthew Sims; Amy M Stubbs; Martin Sundqvist; Måns Ullberg; Karen C Carroll Journal: J Clin Microbiol Date: 2020-08-24 Impact factor: 5.948