Biomarkers and Molecular Analysis to Improve Bloodstream Infection Diagnostics in an Emergency Care Unit

Autor: Peter C. Wever, A. J. M. Loonen, Janna Tosserams, Ron Kusters, Cornelis P.C. de Jager, Adriaan J. C. van den Brule, Mirrian Hilbink
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Bacterial Diseases
Emergency Medical Services
Critical Care and Emergency Medicine
Neutrophils
lcsh:Medicine
Gastroenterology
Procalcitonin
Pathology
Blood culture
lcsh:Science
Whole blood
Multidisciplinary
medicine.diagnostic_test
Area under the curve
Systemic Inflammatory Response Syndrome
Bacterial Pathogens
C-Reactive Protein
Infectious Diseases
Medical Microbiology
Area Under Curve
Medicine
Biomarker (medicine)
Research Article
Calcitonin
medicine.medical_specialty
Calcitonin Gene-Related Peptide
Sensitivity and Specificity
Microbiology
Receptors
Urokinase Plasminogen Activator
Sepsis
Diagnostic Medicine
Internal medicine
medicine
Humans
Lymphocyte Count
Protein Precursors
Biology
Microbial Pathogens
business.industry
lcsh:R
Bloodstream Infections
medicine.disease
ROC Curve
SuPAR
Bacteremia
Immunology
lcsh:Q
business
Biomarkers
General Pathology
Zdroj: PLoS ONE, 9(1):e87315. Public Library of Science
PLoS ONE, Vol 9, Iss 1, p e87315 (2014)
PLoS ONE
ISSN: 1932-6203
Popis: Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ≥ 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699–0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics.
Databáze: OpenAIRE
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