Performance of PCR/electrospray ionization-mass spectrometry on whole blood for detection of bloodstream microorganisms in patients with suspected sepsis

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Performance of PCR/electrospray ionization-mass spectrometry on whole blood for detection of bloodstream microorganisms in patients with suspected sepsis

Strålin, Kristoffer (författare): Karolinska Institutet

Rothman, Richard E. (författare): Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Özenci, Volkan (författare): Karolinska Institutet

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Barkataki, Kieron (författare): Department of Emergency Medicine, Kern Medical Center, Bakersfield, California, USA

Brealey, David (författare): Division of Critical Care, NIHR Biomedical Research Centre at University of College London Hospitals NHS Foundation Trust, London, United Kingdom

Dhiman, Neelam (författare): Molecular Infectious Diseases, med fusion/Quest Diagnostics, Lewisville, Texas, USA

Poling, Lara (författare): AthoGen Testing, Carlsbad, California, USA

Kurz, Michael C. (författare): Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA

Limaye, Ajit P. (författare): University of Washington, Seattle, Washington, USA

LoVecchio, Frank (författare): University of Arizona, Maricopa Medical Center, Phoenix, Arizona, USA

Lowery, Kristin (författare): AthoGen Testing, Carlsbad, California, USA

Miller, Loren G. (författare): Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA

Moran, Gregory J. (författare): Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California, USA

Overcash, J. Scott (författare): eStudySite, Sharp Chula Vista, San Diego, California, USA

Parekh, Amisha (författare): Department of Emergency Medicine, New York Methodist Hospital, New York, New York, USA

Peacock, W. Frank (författare): Baylor College of Medicine, Houston, Texas, USA

Rivers, Emanuel P. (författare): Department of Emergency Medicine and Surgery, Henry Ford Hospital, Detroit, Michigan, USA; Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA

Sims, Matthew (författare): Beaumont Health, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA

Stubbs, Amy M. (författare): Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri, USA

Sundqvist, Martin, 1974- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Laboratory Medicine, Clinical Microbiology

Ullberg, Måns (författare): Karolinska Institutet

Carroll, Karen C. (författare): Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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(creator_code:org_t)

American Society for Microbiology, 2020
2020
Engelska.
Ingår i: Journal of Clinical Microbiology. - : American Society for Microbiology. - 0095-1137 .- 1098-660X. ; 58:9, s. e01860-19

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; visa färre...

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Blood culture (BC) often fails to detect bloodstream microorganisms in sepsis. However, molecular diagnostics hold great potential. The molecular method PCR/electrospray ionization-mass spectrometry (PCR/ESI-MS) can detect DNA from hundreds of different microorganisms in whole blood. The aim of the present study was to evaluate the performance of this method in a multicenter study including 16 teaching hospitals in the USA (n=13) and Europe (n=3). First, on 2,754 contrived whole blood samples, with or without spiked microorganisms, PCR/ESI-MS produced 99.1% true positive and 97.2% true negative results. Secondly, among 1,460 patients with suspected sepsis (sepsis-2 definition), BC and PCR/ESI-MS on whole blood were positive in 14.6% and 25.6% of cases, respectively, with the following result combinations: BC+/PCR/ESI-MS-, 4.3%; BC+/PCR/ESI-MS+, 10.3%; BC-/PCR/ESI-MS+, 15.3%; and BC-/PCR/ESI-MS-, 70.1%. Compared with BC, PCR/ESI-MS showed the following sensitivities (coagulase-negative staphylococci not included): Gram-positive bacteria, 58%; Gram-negative bacteria, 78%; and Candida species, 83%. The specificities were > 94% for all individual species. Patients treated with prior antimicrobial medications (n=603) had significantly increased PCR/ESI-MS positivity rates compared with patients without prior antimicrobial treatment, 31% vs 22% (p<0.0001), with pronounced differences for Gram-negative bacteria and Candida species. In conclusion, PCR/ESI-MS showed excellent performance on contrived samples. On clinical samples, it showed high specificities, moderately high sensitivities for Gram-negative bacteria and Candida species, and elevated positivity rates during antimicrobial treatment. These promising results encourage further development of molecular diagnostics on whole blood for detection of bloodstream microorganisms in sepsis.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Infektionsmedici ...

Artiklar i publikationen: Journal of Clini ...

Av lärosätet: Örebro universitet; Karolinska Institutet

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Performance of PCR/electrospray ionization-mass spectrometry on whole blood for detection of bloodstream microorganisms in patients with suspected sepsis

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