Next-generation microbiological testing in intraabdominal infections with PCR technology.
Intraabdominal infection
PCR testing
Resistant microorganisms
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
03 Apr 2024
03 Apr 2024
Historique:
received:
13
11
2023
accepted:
22
03
2024
medline:
4
4
2024
pubmed:
4
4
2024
entrez:
3
4
2024
Statut:
epublish
Résumé
Intraabdominal infections (IAI) are increasing worldwide and are a major contributor to morbidity and mortality. Among IAI, the number of multi-drug resistant organisms (MDRO) is increasing globally. We tested the Unyvero A50® for intraabdominal infections, compared the detected microorganisms and antibiotic resistance, and compared the results with those of routine microbiology. We prospectively compared samples obtained from surgical patients using PCR-based Unyvero IAI cartridges against routine microbiology for the detection of microorganisms. Additionally, we identified clinical parameters that correlated with the microbiological findings. Data were analyzed using the t-test and Mann-Whitney U test. Sixty-two samples were analyzed. The PCR system identified more microorganisms, mostly Bacteroides species, Escherichia coli, and Enterococcus spp. For bacterial resistance, the PCR system results were fully concordant with those of routine microbiology, resulting in a sensitivity, specificity, and positive and negative predictive value (PPV, NPV) of 100%. The sensitivity, specificity, PPV, and NPV for the detection of microorganisms were 74%, 58%, 60%, and 72%, respectively. CRP levels were significantly higher in patients with detectable microorganisms. We identified more microorganisms and bacterial resistance in hospital-acquired intra-abdominal infections by using the PCR system. IAI warrants early identification of the microorganisms involved and their resistance to allow for adequate antibiotic therapy. PCR systems enable physicians to rapidly adjust their antibiotic treatment. Conventional microbiological culture and testing remain essential for determining the minimal growth inhibition concentrations for antibiotic therapy.
Identifiants
pubmed: 38570375
doi: 10.1007/s00423-024-03298-9
pii: 10.1007/s00423-024-03298-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
108Informations de copyright
© 2024. The Author(s).
Références
Sartelli M, Chichom-Mefire A, Labricciosa FM et al (2017) The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 12:29. https://doi.org/10.1186/s13017-017-0141-6
doi: 10.1186/s13017-017-0141-6
pubmed: 28702076
pmcid: 5504840
Mazuski JE, Tessier JM, May AK et al (2017) The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt) 18(1):1–76. https://doi.org/10.1089/sur.2016.261
doi: 10.1089/sur.2016.261
pubmed: 28085573
Marshall JC, al Naqbi A (2009) Principles of source control in the management of sepsis. Crit Care Clin 25(4):753–68, viii−ix. https://doi.org/10.1016/j.ccc.2009.08.001
doi: 10.1016/j.ccc.2009.08.001
pubmed: 19892251
Morris S, Cerceo E (2020) Trends, epidemiology, and management of multi-drug resistant gram-negative bacterial infections in the hospitalized setting. Antibiotics (Basel) 9(4):196. https://doi.org/10.3390/antibiotics9040196
Sartelli M (2010) A focus on intra-abdominal infections. World J Emerg Surg 5:9. https://doi.org/10.1186/1749-7922-5-9
doi: 10.1186/1749-7922-5-9
pubmed: 20302628
pmcid: 2848006
Goldstein EJC (2002) Intra-abdominal anaerobic infections: bacteriology and therapeutic potential of newer antimicrobial carbapenem, fluoroquinolone, and desfluoroquinolone therapeutic agents. Clin Infect Dis : Off Publ Infecti Dis Soc Am 35(Suppl 1):S106–S111. https://doi.org/10.1086/341930
doi: 10.1086/341930
Murray CJL, Ikuta KS, Sharara F et al (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 399(10325):629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
doi: 10.1016/S0140-6736(21)02724-0
Frickmann H, Masanta WO, Zautner AE (2014) Emerging rapid resistance testing methods for clinical microbiology laboratories and their potential impact on patient management. Biomed Res Int 2014:375681. https://doi.org/10.1155/2014/375681
doi: 10.1155/2014/375681
pubmed: 25343142
pmcid: 4197867
Lodes U, Meyer F, König B, Lippert H (2009) Mikrobiologisches Sepsis-Screening chirurgischer Intensivpatienten mit dem “Lightcycler” Septifast-Test–eine Pilotstudie. Zentralbl Chir 134(3):249–253. https://doi.org/10.1055/s-0028-1098776
doi: 10.1055/s-0028-1098776
pubmed: 19536720
Sancho-Tello S, Bravo D, Borrás R, Costa E, Muñoz-Cobo B, Navarro D (2011) Performance of the LightCycler SeptiFast test Mgrade in detecting microbial pathogens in purulent fluids. J Clin Microbiol 49(8):2988–2991. https://doi.org/10.1128/JCM.00359-11
doi: 10.1128/JCM.00359-11
pubmed: 21715593
pmcid: 3147784
Nagy E, Schuetz A (2015) Is there a need for the antibiotic susceptibility testing of anaerobic bacteria? Anaerobe 31:2–3. https://doi.org/10.1016/j.anaerobe.2014.11.002
doi: 10.1016/j.anaerobe.2014.11.002
pubmed: 25464139
Wexler HM (2007) Bacteroides: the good, the bad, and the nitty-gritty. Clin Microbiol Rev 20(4):593–621. https://doi.org/10.1128/CMR.00008-07
doi: 10.1128/CMR.00008-07
pubmed: 17934076
pmcid: 2176045
Elsaghir H, Reddivari AKR (2023) Bacteroides fragilis. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
Kozlov A, Bean L, Hill EV, Zhao L, Li E, Wang GP (2018) Molecular identification of bacteria in intra-abdominal abscesses using deep sequencing. Open Forum Infect Dis 5(2):ofy025. https://doi.org/10.1093/ofid/ofy025
doi: 10.1093/ofid/ofy025
pubmed: 29479554
pmcid: 5817941
Bloos F, Sachse S, Kortgen A et al (2012) Evaluation of a polymerase chain reaction assay for pathogen detection in septic patients under routine condition: an observational study. PLoS one 7(9):e46003. https://doi.org/10.1371/journal.pone.0046003
doi: 10.1371/journal.pone.0046003
pubmed: 23029360
pmcid: 3459981
Ciesielczuk H, Wilks M, Castelain S et al (2018) Multicenter performance evaluation of the Unyvero IAI cartridge for detection of intra-abdominal infections. Eur J Clin Microbiol Infect Dis : Off Publ Eur Soc Clin Microbiol 37(11):2107–2115. https://doi.org/10.1007/s10096-018-3345-0
doi: 10.1007/s10096-018-3345-0
Healy B, Freedman A (2006) Infections. BMJ 332(7545):838–841. https://doi.org/10.1136/bmj.332.7545.838
doi: 10.1136/bmj.332.7545.838
pubmed: 16601046
pmcid: 1432149
Chauhan MN, Rehman S, Riaz M, Jonker L, Ali D, Zaman S et al (2018) Diagnostic accuracy of CRP & WCC in abdomino-pelvic diseases of non-traumatic acute abdomen by taking CT findings as gold standard. Austin J Surg 5(5):1142
Escadafal C, Incardona S, Fernandez-Carballo BL et al (2020) The good and the bad: using C reactive protein to distinguish bacterial from non-bacterial infection among febrile patients in low-resource settings. BMJ Global Health 5:e002396. https://doi.org/10.1136/bmjgh-2020-002396
Honda T, Uehara T, Matsumoto G, Arai S, Sugano M (2016) Neutrophil left shift and white blood cell count as markers of bacterial infection. Clin Chim Acta 457:46–53. https://doi.org/10.1016/j.cca.2016.03.017
doi: 10.1016/j.cca.2016.03.017
pubmed: 27034055
Ishimine N, Honda T, Yoshizawa A et al (2013) Combination of white blood cell count and left shift level real-timely reflects a course of bacterial infection. J Clin Lab Anal 27(5):407–411. https://doi.org/10.1002/jcla.21619
doi: 10.1002/jcla.21619
pubmed: 24038228
pmcid: 6807635
Parlato M, Philippart F, Rouquette A et al (2018) Circulating biomarkers may be unable to detect infection at the early phase of sepsis in ICU patients: the CAPTAIN prospective multicenter cohort study. Intensive Care Med 44(7):1061–1070. https://doi.org/10.1007/s00134-018-5228-3
doi: 10.1007/s00134-018-5228-3
pubmed: 29959455
Ehler J, Busjahn C, Schürholz T (2022) Welche Biomarker zu Diagnosestellung und Steuerung der antiinfektiven Therapie bei Sepsis? Anaesthesist 71(1):3–11. https://doi.org/10.1007/s00101-021-01067-7
doi: 10.1007/s00101-021-01067-7
pubmed: 34767054
Cantón R, Loza E, Aznar J et al (2019) Monitoring the antimicrobial susceptibility of Gram-negative organisms involved in intraabdominal and urinary tract infections recovered during the SMART study (Spain, 2016 and 2017). Rev Esp Quimioterapia : Publ Oficial de la Soc Esp Quimioterapia 32(2):145–155
de Ruiter J, Weel J, Manusama E, Kingma WP, van der Voort PHJ (2009) The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection 37(6):522–527. https://doi.org/10.1007/s15010-009-8249-6
doi: 10.1007/s15010-009-8249-6
pubmed: 19669089
Shah PM, Edwards BL, Dietch ZC et al (2016) Do polymicrobial intra-abdominal infections have worse outcomes than monomicrobial intra-abdominal infections? Surg Infect (Larchmt) 17(1):27–31. https://doi.org/10.1089/sur.2015.127
doi: 10.1089/sur.2015.127
pubmed: 26397376
Sartelli M, Catena F, Ansaloni L et al (2014) Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg 9:37. https://doi.org/10.1186/1749-7922-9-37
doi: 10.1186/1749-7922-9-37
pubmed: 24883079
pmcid: 4039043
Montravers P, Chalfine A, Gauzit R et al (2004) Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections. Ann Surg 239(3):409–416. https://doi.org/10.1097/01.sla.0000114214.68169.e9
doi: 10.1097/01.sla.0000114214.68169.e9
pubmed: 15075660
pmcid: 1356241
van Ruler O, Kiewiet JJS, van Ketel RJ, Boermeester MA (2012) Initial microbial spectrum in severe secondary peritonitis and relevance for treatment. Eur J Clin Microbiol Infect Dis 31(5):671–682. https://doi.org/10.1007/s10096-011-1357-0
doi: 10.1007/s10096-011-1357-0
pubmed: 21800218
Ferrer R, Martin-Loeches I, Phillips G et al (2014) Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 42(8):1749–1755. https://doi.org/10.1097/CCM.0000000000000330
doi: 10.1097/CCM.0000000000000330
pubmed: 24717459
Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596. https://doi.org/10.1097/01.CCM.0000217961.75225.E9
doi: 10.1097/01.CCM.0000217961.75225.E9
pubmed: 16625125
Kumar A, Ellis P, Arabi Y et al (2009) Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 136(5):1237–1248. https://doi.org/10.1378/chest.09-0087
doi: 10.1378/chest.09-0087
pubmed: 19696123
Wilke M, Worf K, Heinlein W, Kast T, Bodmann K-F (2020) Frühe Optimierung der Antibiotikatherapie durch den schnellen Nachweis von Erregern und Empfindlichkeit : Gesundheitsökonomische Aspekte. Med Klin Intensivmed Notfallmed 115(5):420–427. https://doi.org/10.1007/s00063-020-00680-5
doi: 10.1007/s00063-020-00680-5
Schneider CP, Seyboth C, Vilsmaier M et al (2009) Prognostic factors in critically ill patients suffering from secondary peritonitis: a retrospective, observational, survival time analysis. World J Surg 33(1):34–43. https://doi.org/10.1007/s00268-008-9805-4
doi: 10.1007/s00268-008-9805-4
pubmed: 18979129
Edelsberg J, Berger A, Schell S, Mallick R, Kuznik A, Oster G (2008) Economic consequences of failure of initial antibiotic therapy in hospitalized adults with complicated intra-abdominal infections. Surg Infect (Larchmt) 9(3):335–347. https://doi.org/10.1089/sur.2006.100
doi: 10.1089/sur.2006.100
pubmed: 18570575
Scheer CS, Fuchs C, Gründling M et al (2019) Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study. Clin Microbiol Infect : Off Publ Eur Soc Clin Microbiol Infect Dis 25(3):326–331. https://doi.org/10.1016/j.cmi.2018.05.016
doi: 10.1016/j.cmi.2018.05.016
Cascone VJ, Cohen RS, Dodson NP, Cannon CM (2019) Implications of culture collection after the first antimicrobial dose in septic emergency department patients. Am J Emerg Med 37(5):947–951. https://doi.org/10.1016/j.ajem.2019.02.016
doi: 10.1016/j.ajem.2019.02.016
pubmed: 30777373
Dutta S, Narang A, Chakraborty A, Ray P (2009) Diagnosis of neonatal sepsis using universal primer polymerase chain reaction before and after starting antibiotic drug therapy. Arch Pediatr Adolesc Med 163(1):6–11. https://doi.org/10.1001/archpediatrics.2008.513
doi: 10.1001/archpediatrics.2008.513
pubmed: 19124696
Botes M, de Kwaadsteniet M, Cloete TE (2013) Application of quantitative PCR for the detection of microorganisms in water. Anal Bioanal Chem 405(1):91–108. https://doi.org/10.1007/s00216-012-6399-3
doi: 10.1007/s00216-012-6399-3
pubmed: 23001336
Sinha A, SenGupta S, Guin S et al (2013) Culture-independent real-time PCR reveals extensive polymicrobial infections in hospitalized diarrhoea cases in Kolkata, India. Clin Microbiol Infect : Off Publ Eur Soc Clin Microbiol Infect Dis 19(2):173–180. https://doi.org/10.1111/j.1469-0691.2011.03746.x
doi: 10.1111/j.1469-0691.2011.03746.x
Garrido P, Gabaldó-Barrios X, Pujol-Bajador I et al (2023) Assessing the utility of multiplexed polymerase chain reaction in detecting microorganisms causing infections in critically ill patients. Curr Microbiol 80(11):348. https://doi.org/10.1007/s00284-023-03461-3
doi: 10.1007/s00284-023-03461-3
pubmed: 37733061
pmcid: 10514122
Gajic I, Kabic J, Kekic D, Jovicevic M, Milenkovic M, Mitic Culafic D, Trudic A, Ranin L, Opavski N (2022) Antimicrobial susceptibility testing: A comprehensive review of currently used methods. Antibiotics (Basel) 11(4):427. https://doi.org/10.3390/antibiotics11040427
Gomes AÉI, Stuchi LP, Siqueira NMG et al (2018) Selection and validation of reference genes for gene expression studies in Klebsiella pneumoniae using reverse transcription quantitative real-time PCR. Sci Rep 8(1):9001. https://doi.org/10.1038/s41598-018-27420-2
doi: 10.1038/s41598-018-27420-2
pubmed: 29899556
pmcid: 5998039
Alekshun MN, Levy SB (2007) Molecular mechanisms of antibacterial multidrug resistance. Cell 128(6):1037–1050. https://doi.org/10.1016/j.cell.2007.03.004
doi: 10.1016/j.cell.2007.03.004
pubmed: 17382878
Kowalska-Krochmal B, Dudek-Wicher R (2021) The minimum inhibitory concentration of antibiotics: methods, interpretation, clinical relevance. Pathogens 10(2):165. https://doi.org/10.3390/pathogens10020165
Sim J, Hong SS, Kwak JY, Jung YT (2022) Prediction of culture-positive sepsis and selection of empiric antibiotics in critically ill patients with complicated intra-abdominal infections: a retrospective study. Eur J Trauma Emerg Surg 48(2):963–971. https://doi.org/10.1007/s00068-020-01535-6
doi: 10.1007/s00068-020-01535-6
pubmed: 33145617
Sigakis MJG, Jewell E, Maile MD, Cinti SK, Bateman BT, Engoren M (2019) Culture-negative and culture-positive sepsis: a comparison of characteristics and outcomes. Anesth Analg 129(5):1300–1309. https://doi.org/10.1213/ANE.0000000000004072
doi: 10.1213/ANE.0000000000004072
pubmed: 30829670
pmcid: 7577261
Nannan Panday RS, Lammers EMJ, Alam N, Nanayakkara PWB (2019) An overview of positive cultures and clinical outcomes in septic patients: a sub-analysis of the Prehospital Antibiotics Against Sepsis (PHANTASi) trial. Crit Care 23(1):182. https://doi.org/10.1186/s13054-019-2431-8
doi: 10.1186/s13054-019-2431-8
pubmed: 31113475
pmcid: 6530106