Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

Millar, M.; Zhou, Weiwei; Skinner, Roderick; Pizer, Barry; Hennessy, Enid; Wilks, Mark; Gilbert, Ruth

doi:10.3310/hta15070

Cited by 12 publications

(4 citation statements)

References 138 publications

(232 reference statements)

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“…The technique can be performed with normally sterile biological specimens and also on artificial devices (5-10). However, current studies based on molecular detection of catheter-related bloodstream infection mainly measure levels of bacterial DNA in blood samples drawn through the catheter using commercially available real-time PCR (17)(18)(19). Therefore, at present, no data are available on the yield of universal 16S rRNA PCR performed on the catheter in situ, irrespective of the type of catheter.…”

Section: Discussionmentioning

confidence: 99%

Use of Universal 16S rRNA Gene PCR as a Diagnostic Tool for Venous Access Port-Related Bloodstream Infections

et al. 2013

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Amplification of the universal 16S rRNA gene using PCR has improved the diagnostic yield of microbiological samples. However, no data have been reported on the reliability of this technique with venous access ports (VAPs). We assessed the utility of 16S rRNA PCR for the prediction of VAP-related bloodstream infection (VAP-RBSI). During a 2-year period, we prospectively received all VAPs removed by interventional radiologists. PCR and conventional cultures were performed using samples from the different VAP sites. We compared the results of PCR with those of conventional culture for patients with confirmed VAP-RBSI. We collected 219 VAPs from 219 patients. Conventional VAP culture revealed 15 episodes of VAP-RBSI. PCR revealed a further 4 episodes in patients undergoing antibiotic therapy which would have gone undetected using conventional culture. Moreover, it had a negative predictive value of 97.8% for the prediction of VAP-RBSI when it was performed using biofilm from the internal surface of the port. In conclusion, universal 16S rRNA PCR performed with samples from the inside of VAPs proved to be a useful tool for the diagnosis of VAP-RBSI. It increased detection of VAP-RBSI episodes by 21.1% in patients undergoing antibiotic therapy whose episodes would have gone undetected using conventional culture. Therefore, we propose a new application of 16S rRNA PCR as a useful tool for the diagnosis of VAP-RBSI in patients receiving antibiotic therapy. C onfirmation of colonization of venous access ports (VAPs) requires culture of both port reservoir contents and the catheter tip (1). However, conventional culture of VAPs could prove negative when antibiotic therapy is prescribed before catheter withdrawal. Therefore, an episode of VAP-related bloodstream infection (VAP-RBSI) might not be confirmed, as diagnosis requires the isolation of the same microorganism in blood culture as in the colonized VAP (2-4).Molecular techniques overcome some of the limitations of conventional culture under several clinical conditions (5-10). Nevertheless, the role of molecular techniques in the diagnosis of VAP-RBSI remains unclear, and available approaches have not been extensively tested in the routine of a clinical microbiology laboratory.Our main objective was to assess the validity values of 16S rRNA PCR to analyze VAPs from patients with confirmed VAP-RBSI. MATERIALS AND METHODSSetting. Ours was a prospective study performed between July 2009 and April 2011 at a large institution in Madrid, Spain.We included all tunneled VAPs (Port-A-Caths) that were routinely removed in the Department of Vascular Interventional Radiology, irrespective of the reason for withdrawal. We also included those devices with suspicion of infection that were removed in surgery departments or emergency rooms.We excluded VAPs that were colonized exclusively by fungi. Laboratory procedures. When the VAPs arrived at the microbiology laboratory, we performed culture and broad-range real-time 16S rRNA gene PCR followed by direct sequencing using port content ...

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Section: Discussionmentioning

confidence: 99%

Use of Universal 16S rRNA Gene PCR as a Diagnostic Tool for Venous Access Port-Related Bloodstream Infections

et al. 2013

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“…Studies have shown that neonatal sepsis is often associated with lower colony forming units of bacteria in the blood [25,26], which may contribute to the low biomass of the extracted microbial DNA. A previous study demonstrated that the microbial DNA load of blood (> 0.5 pg/μl) collected from the catheters (n = 207) in children with cancer can detect catheter infections in 61% (95% CI 44 to 83%) of those classified as probable central venous catheter-associated infection with 88% specificity (95% CI 84 to 92%) [27]. High DNA load was associated with higher specificity for diagnosing catheter infection and predicted subsequent catheter removal in this study.…”

Section: Discussionmentioning

confidence: 99%

Microbiome signatures in neonatal central line associated bloodstream infections

et al. 2020

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Neonates are at high risk for central line associated bloodstream infections (CLABSI). Biofilm formation is universal on indwelling catheters but why some biofilms seed the bloodstream to cause CLABSI is not clearly understood. With the objective to test the hypothesis that catheter biofilm microbiome in neonates with CLABSI differs than those without infection, we prospectively enrolled neonates (n = 30) with infected and uninfected indwelling central catheters. Catheters were collected at the time of removal, along with blood samples and skin swabs at the catheter insertion sites. Microbiomes of catheter biofilms, skin swabs and blood were evaluated by profiling the V4 region of the bacterial 16S rRNA gene using Illumina MiSeq sequencing platform. The microbial DNA load was higher from catheter biofilms of CLABSI patients without differences in alpha diversity when compared to that of the non-CLABSI neonates. Proteus and unclassified Staphylococcaceae were more abundant in infected catheter biofilms while Bradyrhizobium, Cloacibacterium, and Sphingomonas were more abundant in the uninfected catheters. A blood microbiome was detected in uninfected samples. The blood microbiome in CLABSI neonates clustered separately from the uninfected blood samples in beta diversity plots. We found that the microbiome signature in catheter biofilm and blood of neonates with CLABSI is different than the microbiomes of non-CLABSI neonates.

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“…Antimicrobial therapy should be stopped in case that the cause of sepsis was detected as something other than infection. The removal of infected intravascular devices, especially central venous catheters, if possible and if preferred to antibiotic lock methods, will reduce mortality and increase the chances that the infection will be cured [5,64].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Sepsis in Children

Öncel¹

2017

Intensive Care

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Sepsis is systemic inflammatory response syndrome due to a documented or suspected infection. Causative agents of sepsis include group B streptococcus, Escherichia coli, and Listeria monocytogenes in infants younger than 2 months, and communityacquired organisms. Bacteremia may ensue in patients whose defense mechanisms have become vulnerable due to many factors. Sepsis and septic shock can be viewed as clinical pictures, which develop as consequences of proinflammatory processes/ cytokines leading to a state that cannot be restrained by anti-inflammatory processes/ cytokines. As yet, a cytokine, which is uniquely associated with severe sepsis and septic shock and can be used as a biomarker, has not been discovered. Sepsis is a cytokine storm, which may adversely affect almost any organ system. Whether there is an association between the severity of sepsis or septic shock and cytokine gene polymorphisms is an important field of study. Mottled skin and prolongation of capillary refill time may help the physician recognize septic shock before hypotension emerges. The management of severe sepsis and septic shock involves (1) the hemodynamic support, (2) inotropes, vasopressors, and vasodilators, (3) antimicrobial therapy, (4) transfusions, and (5) corticosteroids as indicated. Hospital mortality of pediatric sepsis is 2-10%.

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Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

Cited by 12 publications

References 138 publications

Use of Universal 16S rRNA Gene PCR as a Diagnostic Tool for Venous Access Port-Related Bloodstream Infections

Use of Universal 16S rRNA Gene PCR as a Diagnostic Tool for Venous Access Port-Related Bloodstream Infections

Microbiome signatures in neonatal central line associated bloodstream infections

Sepsis in Children

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