The potential utility of real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal sepsis

İstanbullu, Kenan; Köksal, Nilgün; Çetınkaya, Merih; Özkan, Hilal; Yakut, Tahsin; Karkucak, Mutlu; Doğan, Haldun

doi:10.24953/turkjped.2019.04.004

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Attempts to determine the use of this molecular tool in the diagnosis of meningitis has also been made, although the clinical relevance remains ambiguous due to very small sample sizes in these studies [ 19 , 29 ]. In the same way, other researchers have looked into its clinical importance in blood and urine samples in the diagnosis of neonatal sepsis [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Most of these studies have demonstrated important clinical worth of 16S rRNA sequencing in the diagnosis of particular infections in children, albeit there are differences in the diagnostic yield across these studies brought about by factors such as specimen types and differing institutional practices.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there is a paucity of data on the clinical utility of 16S rRNA sequencing in pediatric infections [ 2 , 6 ]. Few studies highlight the diagnostic utility of 16S rRNA sequencing in select pediatric infections [ 16 , 17 , 18 , 19 , 20 ]. Most of these studies have attempted to isolate its clinical usefulness in the diagnosis of neonatal sepsis [ 21 , 22 , 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections

et al. 2022

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The use of 16S rRNA sequencing in culture-negative infections has improved identification of bacterial pathogens in select scenarios, but its clinical impact requires further elucidation, especially in the pediatric population. This retrospective study aims to determine the clinical utility of 16S rRNA sequencing on the clinical management of pediatric culture-negative infections in our institution. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p < 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n = 9, 30%), followed equally by joint fluid (n = 6, 20%) and bone (n = 6, 20%), with no difference between fluid and fresh tissue specimens (p = 0.346). Although the difference was not statistically significant (p = 0.4111), the overall use of broad-spectrum coverage was decreased. The median number of antibiotics was decreased from two to one (p < 0.0001) based on 16S rRNA sequencing results. The results suggest that 16S rRNA sequencing has a significant impact on decreasing the number of antibiotics used in the treatment of pediatric culture-negative infections. 16S rRNA sequencing performed on pulmonary specimens has the highest likelihood of identifying a pathogen compared to other specimen types. Additional cost–benefit analysis needs to be completed to further determine clinical benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections

et al. 2022

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“…It is unclear how well this test performs at detecting polymicrobial infections, but the overall diagnostic potential is hampered by its very poor sensitivity (29-47%) [82,83]. Istanbullu et al evaluated the performance of 16S rRNA gene qPCR using hydrolysis probes for the diagnosis of neonatal sepsis, and reported sensitivity and specificity of 16.6% and 97.8%, respectively [84]. However, it is important to note that many of these PCR tests have high negative predictive values (up to 95%), suggesting they would be more appropriate as screening tools to exclude infections, predict patient outcomes and monitor therapy rather than to identify pathogens [84,85].…”

Section: Pcr On Whole Bloodmentioning

confidence: 99%

Molecular Methodologies for Improved Polymicrobial Sepsis Diagnosis

Doualeh

Payne

Litton

et al. 2022

IJMS

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Polymicrobial sepsis is associated with worse patient outcomes than monomicrobial sepsis. Routinely used culture-dependent microbiological diagnostic techniques have low sensitivity, often leading to missed identification of all causative organisms. To overcome these limitations, culture-independent methods incorporating advanced molecular technologies have recently been explored. However, contamination, assay inhibition and interference from host DNA are issues that must be addressed before these methods can be relied on for routine clinical use. While the host component of the complex sepsis host–pathogen interplay is well described, less is known about the pathogen’s role, including pathogen–pathogen interactions in polymicrobial sepsis. This review highlights the clinical significance of polymicrobial sepsis and addresses how promising alternative molecular microbiology methods can be improved to detect polymicrobial infections. It also discusses how the application of shotgun metagenomics can be used to uncover pathogen/pathogen interactions in polymicrobial sepsis cases and their potential role in the clinical course of this condition.

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“…Upon title and abstract review, 1368 studies were excluded, and 119 were subjected to full-text review. Of these, 100 were excluded because valid data could not be extracted, and the remaining 19 articles were included in our study [12,13,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Figure 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All studies used a prospective study design to avoid inappropriate exclusion (Figure 2). Five studies did not specify whether patients were continuously enrolled or not [25,26,[28][29][30]. The remaining studies specified continuous enrollment.…”

Section: Study Characteristicsmentioning

confidence: 99%

The Accuracy of 16S rRNA Polymerase Chain Reaction for the Diagnosis of Neonatal Sepsis: A Meta‐Analysis

Wang

Zhao²,

Yao

et al. 2021

BioMed Research International

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Objective. To determine the accuracy of 16S rRNA polymerase chain reaction (PCR) for the diagnosis of neonatal sepsis through a systematic review and meta-analysis. Methods. Studies involving 16S rRNA PCR tests for the diagnosis of neonatal sepsis were searched in the PubMed, Medline, Embase, and Cochrane Library databases. The methodological quality of the identified studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and the sensitivity, the specificity, the positive likelihood ratio (PLR), the negative likelihood ratio (NLR), the diagnostic odds ratio (DOR), and the area under the curve (AUC) of operator characteristic (SROC) curves were determined. Heterogeneity between studies was analyzed by metaregression. Stata 14.0 and Meta-disc 1.4 software were used for the analyses. Results. This meta-analysis included 19 related studies. The analysis found a sensitivity of 0.98 (95% CI: 0.85-1), specificity of 0.94 (95% CI: 0.87-0.97), PLR of 16.0 (95% CI: 7.6-33.9), NLR of 0.02 (95% CI: 0.00-0.18), DOR of 674 (95% CI: 89-5100), and AUC of 0.99 (95% CI: 0.97-0.99). Metaregression analysis identified Asian countries, arterial blood in blood samples, and sample size > 200 as the main sources of heterogeneity. This meta-analysis did not uncover publication bias. Sensitivity analysis showed that the study was robust. Fagan’s nomogram results showed clinical usability. Conclusions. The results from this meta-analysis indicate that 16S rRNA PCR testing is effective for the rapid diagnosis of neonatal sepsis.

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The potential utility of real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal sepsis

Cited by 9 publications

References 22 publications

Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections

Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections

Molecular Methodologies for Improved Polymicrobial Sepsis Diagnosis

The Accuracy of 16S rRNA Polymerase Chain Reaction for the Diagnosis of Neonatal Sepsis: A Meta‐Analysis

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