Microbial diagnostics in patients with presumed severe infection in the emergency department

• Published in: Medizinische Klinik - Intensivmedizin und Notfallmedizin 2012-02, Vol.107 (1), p.53-62
• Main Authors: Hettwer, S., Wilhelm, J., Schürmann, M., Ebelt, H., Hammer, D., Amoury, M., Hofmann, F., Oehme, A., Wilhelms, D., Kekulé, A.S., Klöss, T., Werdan, K.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bacterial Infections - diagnosis; Bacterial Infections - microbiology; Bacteriological Techniques; Blood - microbiology; Calcitonin - blood; Calcitonin Gene-Related Peptide; Cooperative Behavior; Critical Care Medicine; Culture Media; Early Diagnosis; Emergency Medicine; Emergency Service, Hospital; Female; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - microbiology; Humans; Intensive; Interdisciplinary Communication; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Multiplex Polymerase Chain Reaction; Mycoses - diagnosis; Mycoses - microbiology; Originalarbeit; Predictive Value of Tests; Prospective Studies; Protein Precursors - blood; Sepsis - diagnosis; Sepsis - microbiology; Sleep, REM; Staphylococcal Infections - diagnosis; Staphylococcal Infections - microbiology
• ISSN: 2193-6218; 1615-6722; 2193-6226
• DOI: 10.1007/s00063-011-0051-4

Introduction Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test. Methods At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. Results Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only ( n =20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0±23.3 vs. 8.8±32.8 ng/ml, p