Broad-range polymerase chain reaction (PCR) is increasingly used in patients with culture-negative infections; however, few studies have assessed the diagnostic utility of this test in this context. We performed a retrospective cohort study of patients who had clinical specimens sent for broad-range PCR, aiming to evaluate performance and determine impact on patient management. Organisms were identified in 21/71 samples. High numbers of polymorphonuclear leukocytes on Gram stain (odds ratio [OR], 4.17; P = .04) and acute inflammation on histopathology (OR, 5.69; P = .02) were significantly associated with a positive result. Management was altered in 18 patients, 11 with positive and 7 with negative results. Overall, broad-range PCR assay had the highest impact in patients with microscopic evidence of inflammation. Physicians ordering this complex, difficult to interpret, and expensive test should carefully consider all available clinical information on an individualized basis to optimize its performance.

BackgroundChronic hemodialysis patients frequently require anticoagulation treatment with warfarin for a variety of co-morbidities. The optimal method for monitoring and dose adjustment of warfarin-based anticoagulation in this population, however, remains unclear. To examine this more closely, we reviewed all hemodialysis patients at a single institution on chronic warfarin therapy for a 10-month period prior to and after the institution of a standardized protocol for warfarin dose adjustment and monitoring. Anticoagulation efficacy was assessed by time within the therapeutic INR range (TTR), and resource utilization was assessed by the number of weekly INR measurements required for monitoring.ResultsWe retrospectively analyzed 4481 patient-days of warfarin therapy data (from 25 hemodialysis patients) in the pre-protocol timeframe, and 3308 patient-days of warfarin therapy data (from 21 hemodialysis patients) in the on-protocol timeframe. Time within the therapeutic INR range (TTR) did not improve with institution of the dosing protocol—51.18% using non protocol-based management, and 51.57% using protocol-based management (p 0.73). However, overall resource utilization was reduced with institution of protocolized warfarin monitoring—from 1.71 INR measurements per patient-week pre-protocol, to 1.20 INR measurements per patient-week (p < 0.0001) post-protocol.ConclusionsIn this single-center study, institution of a standardized dosing protocol in a hemodialysis population on chronic warfarin therapy did not improve the rate of on-target anticoagulation, but did result in significantly lower resource utilization. We support protocol-based warfarin management in the hemodialysis population, but future work should examine the rate of on-target anticoagulation typically achieved in this group.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2381-7) contains supplementary material, which is available to authorized users.

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BackgroundOver the past decade, detection of bacterial and fungal DNA by universal polymerase chain reaction (PCR) has been increasingly used for organism identification in culture negative tissue samples. Few studies have assessed the diagnostic utility of this test in real-world clinical practice. The aim of this study was to assess the clinical performance of this test by examining available clinical information, test results and the impact on patient management.MethodsWe performed a single-center retrospective cohort study of patients who had clinical specimens sent for universal PCR from August 2013 to April 2016. Clinical data were extracted from medical records. Odds ratios were calculated and patients testing positive/negative were compared with univariate logistic regression. Sensitivity, specificity, positive predictive value and negative predictive values were calculated by comparing the test result with a gold standard composite final clinical diagnosis determined by 3 independent reviewers based on all available clinical information.Results71 tissue samples were included, of which 21(29.6%) were positive. 12 bacteria, 3 mycobacteria and 7 fungi were identified. The number of leukocytes in the gram stain (odds ratio, OR 1.57, P = 0.04) and presence of inflammation on histopathological examination (OR 5.69, P = 0.02) were found to be significantly associated with a positive result. The sensitivity, specificity, positive predictive value, and negative predictive values were 56%, 95%, 91% and 70% respectively. Management was altered in 22 patients, 9 of whom had a positive and 13 had a negative result.ConclusionThese findings suggest that the universal PCR assay has significant clinical utility, but the yield of this test can be optimized by careful patient/specimen selection. Utility was highest in patients with microscopic evidence of inflammation by gram stain or histopathlogical examination. Specificity was high. The use of this complex, difficult to interpret, and expensive test should be limited to infectious disease physicians incorporating all available clinical information to optimize performance.Disclosures All authors: No reported disclosures.

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