Evaluation of a real-time PCR assay for detection and quantification of bacterial DNA directly in blood of preterm neonates with suspected late-onset sepsis

Marre van den Brand*, Frank A. M. van den Dungen, Martine P. Bos, Mirjam M. van Weissenbruch, A. Marceline van Furth, Annemieke de Lange, Anna Rubenjan, Remco P. H. Peters, Paul H. M. Savelkoul

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Web of Science)

Abstract

Background: Rapid and accurate diagnosis of neonatal sepsis is highly warranted because of high associated morbidity and mortality. The aim of this study was to evaluate the performance of a novel multiplex PCR assay for diagnosis of late-onset sepsis and to investigate the value of bacterial DNA load (BDL) determination as a measure of infection severity. Methods: This cross-sectional study was conducted in a neonatal intensive care unit. Preterm and/or very low birth weight infants suspected for late-onset sepsis were included. Upon suspicion of sepsis, a whole blood sample was drawn for multiplex PCR to detect the eight most common bacteria causing neonatal sepsis, as well as for blood culture. BDL was determined in episodes with a positive multiplex PCR. Results: In total, 91 episodes of suspected sepsis were investigated, and PCR was positive in 53 (58%) and blood culture in 60 (66%) episodes, yielding no significant difference in detection rate (p = 0.17). Multiplex PCR showed a sensitivity of 77%, specificity of 81%, positive predictive value of 87%, and negative predictive value of 68% compared with blood culture. Episodes with discordant results of PCR and blood culture included mainly detection of coagulase-negative staphylococci (CoNS). C-reactive protein (CRP) level and immature to total neutrophil (I/T) ratio were lower in these episodes, indicating less severe disease or even contamination. Median BDL was high (4.1 log(10) cfu Eq/ml) with a wide range, and was it higher in episodes with a positive blood culture than in those with a negative blood culture (4.5 versus 2.5 log(10) cfu Eq/ml; p < 0.0001). For CoNS infection episodes BDL and CRP were positively associated (p = 0.004), and for Staphylococcus aureus infection episodes there was a positive association between BDL and I/T ratio (p = 0.049). Conclusions: Multiplex PCR provides a powerful assay to enhance rapid identification of the causative pathogen in late-onset sepsis. BDL measurement may be a useful indicator of severity of infection.
Original languageEnglish
Article number105
Number of pages10
JournalCritical Care
Volume22
DOIs
Publication statusPublished - 22 Apr 2018

Keywords

  • Molecular diagnosis
  • Late-onset sepsis
  • Neonatology
  • Real-time PCR
  • Bacterial DNA load
  • Bacteremia
  • POLYMERASE-CHAIN-REACTION
  • BIRTH-WEIGHT INFANTS
  • STREAM INFECTIONS
  • RAPID DIAGNOSIS
  • NECROTIZING ENTEROCOLITIS
  • MOLECULAR-DETECTION
  • METAANALYSIS
  • CHILDREN
  • DISEASE
  • LOAD

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