Performance of real-time PCR in suspected haemodialysis catheter-related bloodstream infection: a proof-of-concept study.

Autor: Acquier M; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France., Zabala A; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France., de Précigout V; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France., Delmas Y; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France., Dubois V; Laboratoire de Bactériologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France., de la Faille R; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France., Rubin S; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.; Unité Inserm, UMR1034, Biologie des Maladies Cardiovasculaires, Université de Bordeaux, Pessac, France., Combe C; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.; Unité Inserm 1026 Biotis, Université de Bordeaux, Bordeaux, France., M'Zali F; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France., Kaminski H; Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.; CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2022 Oct 29; Vol. 16 (3), pp. 494-500. Date of Electronic Publication: 2022 Oct 29 (Print Publication: 2023).
DOI: 10.1093/ckj/sfac242
Abstrakt: Background: Catheter-related bloodstream infections (CRBIs) remain a major cause of mortality in haemodialysis (HD) patients with central venous catheters (CVCs), especially because of the non-specific symptomatology and the delay in microbiological diagnosis with possible use of non-optimal empiric antibiotics. Moreover, empiric broad-spectrum antibiotics increase antibiotic resistance development. This study aims to evaluate the diagnostic performance of real-time polymerase chain reaction (rt-PCR) in suspected HD CRBIs compared with blood cultures.
Methods: A blood sample for rt-PCR was collected simultaneously with each pair of blood cultures for suspected HD CRBI. The rt-PCR was performed on the whole blood, without any enrichment stage and with specific DNA primers: 16S (universal bacterial), Staphylococcus spp., Staphylococcus aureus and mecA . Each successive patient with a suspected HD CRBI in the HD centre of Bordeaux University Hospital was included. Performance tests were used to compare the result obtained in each rt-PCR assay with its corresponding routine blood culture.
Results: Eighty-four paired samples were collected and compared for 40 suspected HD CRBI events in 37 patients. Among these, 13 (32.5%) were diagnosed as HD CRBI. All rt-PCRs except mecA (insufficient number of positive samples) showed high diagnostic performances within 3.5 h: 16S (sensitivity 100%, specificity 78%), Staphylococcus spp. (sensitivity 100%, specificity 97%), S. aureus (sensitivity 100%, specificity 99%). Based on the rt-PCR results, antibiotics could be more appropriately targeted, thus cutting anti-cocci Gram-positive therapy from 77% to 29%.
Conclusions: The performance of rt-PCR in suspected HD CRBI events showed fast and high diagnostic accuracy. Its use would improve HD CRBI management with an antibiotic consumption decrease.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)
Databáze: MEDLINE
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